Doctors: Patients Using Too Much Medical Care

If you go to the doctor with a minor ailment, you could end up going through a battery of tests and expensive treatments. You might consider it excessive, and so might your doctor.

A survey of U.S. primary care physicians shows that many believe that their own patients are receiving too much medical care. The study, published in the Archives of Internal Medicine, says doctors think that pressures to avoid lawsuits prompt them to order health services that might not really be justified.

Realigning financial incentives and having more time with patients could reduce pressures on physicians to do more than they feel is needed, the doctors say.

Twice the health care spending

“Per capita U.S. health care spending exceeds, by a factor of two, that of the average industrialized nation and is growing at an unsustainable rate,” the authors write as background information in the article. “A number of health care epidemiologists and economists, however, have suggested that a substantial amount of U.S. health care is actually unnecessary.”

Brenda E. Sirovich, M.D., M.S., and colleagues from the VA Outcomes Group, White River Junction, Ver., and the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, N.H., conducted a national mail survey of U.S. primary care physicians.

Forty-two percent of all survey respondents believe that patients in their own practice receive too much medical care, while only six percent believe that their patients receive too little care.

Aggressive practice

Additionally, 28 percent of respondents said they personally were practicing more aggressively than they would like, and 29 percent felt that other primary care physicians in their community were practicing too aggressively.

Study participants identified three factors they believe cause physicians to practice too aggressively: malpractice concerns (76 percent), clinical performance measures (52 percent) and inadequate time to spend with patients (40 percent).

Eighty-three percent of physicians felt they could easily be sued for failing to order a test that was indicated, while 21 percent felt that they could be sued for ordering a test that was not indicated.

The authors conclude that their results show that, “physicians are open to practicing more conservatively.” They also note that, “physicians believe they are paid to do more and exposed to legal punishment if they do less.

Reimbursement systems, they say, should encourage longer primary care physician visits and telephone, e-mail and nursing follow-up, rather than diagnostic intensity.”