Many Doctors Think Patients Get Over-Treated, Study Says
Malpractice concerns influence many testing decisions, U.S. physicians say
By Maureen Salamon
MONDAY, Sept. 26 (HealthDay News) -- When it comes to medical care, nearly half of U.S. primary care physicians believe their own patients are over-treated.
A national mail survey of 627 doctors randomly selected from the American Medical Association Physician Masterfile showed that 42 percent believe patients in their own practice get too much medical care, while 52 percent think the amount of care is just right.
But only 6 percent believe their patients receive too little care, the survey found.
"Remember, these are patients in their own practice -- that's an important part of the way we chose to ask the question," said study author Dr. Brenda Sirovich, a staff physician and research associate at the VA Outcomes Group in White River Junction, Vt., and an associate professor of community and family medicine at the Dartmouth Institute for Health Policy and Clinical Practice.
"Presumably these physicians have a hand in overseeing their patients' care," Sirovich added. "We believe that's a provocative finding. The most important thing we found is that primary care physicians see there's a problem with the excesses of the health care system, and successful reform would be much harder if successful physicians didn't see that and weren't engaged in the solution."
The study is published Sept. 26 in the Archives of Internal Medicine.
Sirovich and her colleagues said several measures, including malpractice reforms or having more time with patients, could reduce pressure on doctors to offer more care than they feel is needed. Many health care epidemiologists and economists have suggested that much U.S. health care is actually unnecessary, the study authors said.
The survey, conducted between June and December 2009, also found that 28 percent of respondents said they were practicing more aggressively -- such as ordering more tests -- than they would like, while 29 percent felt other primary care physicians in their community were practicing too aggressively.
Almost all said they believed that primary care physicians vary in patient testing and treatment, and three-quarters were interested in learning how their own practice compared to others.
Malpractice concerns drive many decisions to treat aggressively, the doctors said. More than 80 percent felt they could easily be sued for failing to order a test that was indicated, while 21 percent felt they could be sued for ordering a test that wasn't. Having too little time with patients was cited by 40 percent as another reason for aggressive treatment.
"The whole survey is based on their opinions and perceptions, and that's really what we were going after," Sirovich said. "Of course, there are limitations inherent in asking physicians what they themselves do . . . among them may be the natural desire to be viewed favorably, which is why we also asked about other physicians -- which of course is speculative. That's the nature of the design of the study."
While few doctors said they order expensive treatments to boost their own income, nearly two-thirds suggested that other doctors might do so.
In a commentary published with the study, Dr. Calvin Chou, a professor of medicine at the University of California, San Francisco, said the findings imply a "trained helplessness" among physicians since they know they are practicing aggressively but feel they have no recourse.
"I would say most doctors probably feel somewhat helpless when they're expected to practice defensive medicine and check off a whole bunch of boxes," said Chou, also a general internist at San Francisco Veterans Affairs Medical Center. "I think when you're running scared all the time and have a whole bunch of boxes to check . . . more and more doctors feel like they're under the gun and are less likely to be able to rise above it. I think it's possible, but it requires perspective."
"We were very intrigued that a large majority of physicians are interested in where they stand in relation to other physicians," Sirovich said. "We think that means they're open to feedback and to practicing differently."
The U.S. National Library of Medicine has information about choosing a primary care provider.SOURCES: Brenda Sirovich, M.D., M.S., staff physician and research associate, VA Outcomes Group, White River Junction, Vt., and associate professor, medicine, and community and family medicine, Dartmouth Medical School and Dartmouth Institute for Health Policy and Clinical Practice, Hanover, N.H.; Calvin Chou, M.D., Ph.D., professor of medicine, University of California, San Francisco, and general internist, San Francisco Veterans Affairs Medical Center; Sept. 26, 2011, Archives of Internal Medicine Related Articles
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