Physicians trying a 'less is more' approach to clinical care by limiting "low-value" tests or procedures often received pushback from patients, according to a 乌鸦传媒 reader survey.
About two-thirds of the doctors surveyed said patients resisted their efforts and requested more tests or other procedures after initially being advised otherwise.
Nearly 390 doctors completed the survey, emailed to readers of 乌鸦传媒 from May 4 to 15. Although not necessarily representative of the medical community, the survey still shows how some physicans balance providing healthcare to patients who think they need certain procedures or tests.
Unnecessary testing is a serious problem in medicine, according to 85% of survey respondents. More than 80% of the physicians said they are trying to limit what they view as "low-value" procedures. CT scans, MRIs and x-rays were the three the most common tests identified in the survey as providing low value for the costs or risk.
"I'd rather explain what is happening in my best estimation, rather than give a plethora of marginally linked tests," said Tom Bellinger, MD, of Michigan.
Bellinger, who practices family medicine said he tries to provide more explanatory workups, rather than labs. Stephanie Delbert, ARNP, a nurse practitioner in central Florida, follows similar protocol.
"They'll usually listen," she said of patients, "but sometimes I have to spend time explaining that the test likely won't show anything that I don't already know."
Knowing when a screenings are necessary can come down to experience said Michael Rothstein, MSN, FNP, who works at the New York College of Podiatric Medicine.
"I tell my students that 'you have to know when to limit so you're not doing the million-dollar workup unnecessarily," he said.
Unnecessary screenings are fairly common said John W. Thompson, MD, of Portland, Ore., who retired as an orthopedic surgeon. He also worked as an independent medical evaluator for the state of Oregon for 14 years and reviewed medical files of injured workers.
"It wasn't at all uncommon to find an injured worker who had three MRIs in the past year and no true evidence of the condition getting worse," he said. "The third wouldn't show anything different from the first one, but they still got all three."
Eric Udell, ND, M.Ed., of Tempe, Ariz., said that a push to limit certain screens has its limitations, particularly if it puts a doctor at risk for litigation.
"I think that it has become one of the major whipping posts or scapegoats and I'm not sure that's its solely deserving of that level of blame." he said. "It's a tradeoff that we have to be aware of. Simply starting to limit certain tests has tradeoffs that aren't often discussed. What about running a test for a peace of mind? You feel pretty sure that a test is not necessary, but the patient is going to continue to have some anxiety and stress about the issue until the test confirms it."
Douglas Ashinsky, MD, who practices internal medicine in New Jersey, said he thinks the "less is more" movement often oversimplifies the issue.
"Every person that I see in my office is not the same," he said. "Every one responds to different treatments, guidelines differently. Guidelines are just that -- guidelines."
Survey respondents were self-selected from 乌鸦传媒's readership, and are not necessarily representative of all practicing physicians in the U.S. For example, more than two-thirds have practiced for at least 16 years and about 30% are in a solo practice, both of which are much higher than the general physician population. Only about 18% of physicians are in solo practice, .