Overwhelming Majority Of ED Physicians Order Unnecessary Tests
By Christine Kern, contributing writer
Ninety-seven of those surveyed ordered tests that were “medically unnecessary.”
A survey published by Academic Emergency Medicine found 97 percent of respondents admitted to ordering tests that were “medically unnecessary” as a result of external pressures including fear of errors and uncertainty. Additionally, 85 percent of the respondents said they believe too many tests are ordered in their own departments.
The study, “Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging,” focused specifically on imaging tests, and polled 435 emergency physicians.
“Overall, I interpret our results to suggest that over-testing is not due to physicians' lack of knowledge or lack of insight or poor medical judgment, but reflects a cultural response both within and outside medicine to uncertainty and error,” lead author Hemal Kanzaria, MD told HealthLeaders Media. “I personally think that to overcome over-testing we need to address our collective intolerance of uncertainty both within medicine and within society at large as well as this culture of blame that triggers the malpractice system.”
But the proper approach to fix the broken system is not clearly delineated. “There is not one magic bullet. I don't think that any isolated approach to curbing over-imaging exists,” Kanzaria says. “There is one idea that is being discussed right now, the idea of safe harbors. Using clinical practice guidelines to determine the local standard of care might help physicians follow both evidence based guidelines and offer some protections from malpractice and could potentially result in fewer medically unnecessary tests.”
“Acknowledging that uncertainty exists both for the physicians and for their patients may be a good first step,” Kanzaria said. “Beyond that, addressing our low tolerance for uncertainty on the part of physicians and patients will really require addressing a number of widespread beliefs that are held in society, including the perception that error is the cause of any bad outcome, or that technology can solve all of our problems, or that catching things early is always beneficial. Myths like that we will have to address.”
The survey’s finding that nine out of 10 emergency physicians admit to ordering medically unnecessary tests indicate existing protocols and safeguards to prevent overuse clearly aren't working.