1. Examining primary care physician rationale for not following geriatric choosing wisely recommendations
- Author
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Theresa A. Rowe, Tiffany Brown, Stephen D. Persell, Jeffrey A. Linder, and Jason N. Doctor
- Subjects
Male ,medicine.medical_specialty ,Medicine (General) ,01 natural sciences ,Physicians, Primary Care ,03 medical and health sciences ,0302 clinical medicine ,Qualitative analysis ,R5-920 ,Overuse ,Medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,0101 mathematics ,Practice Patterns, Physicians' ,Aged ,Oral hypoglycemic ,business.industry ,010102 general mathematics ,Deference ,Primary care physician ,Patient preference ,Test (assessment) ,Choosing Wisely ,Harm ,Geriatrics ,Family medicine ,Older adults ,Female ,Family Practice ,business ,Research Article - Abstract
Background The objective is to understand why physicians order tests or treatments in older adults contrary to published recommendations. Methods Participants: Physicians above the median for ≥ 1 measures of overuse representing 3 Choosing Wisely topics. Measurements: Participants evaluated decisions in a semi-structured interview regarding: 1) Screening men aged ≥ 76 with prostate specific antigen 2) Ordering urine studies in women ≥ 65 without symptoms 3) Overtreating adults aged ≥ 75 with insulin or oral hypoglycemic medications. Two investigators independently coded transcripts using qualitative analysis. Results Nineteen interviews were conducted across the three topics resulting in four themes. First, physicians were aware and knowledgeable of guidelines. Second, perceived patient preference towards overuse influenced physician action even when physicians felt strongly that testing was not indicated. Third, physicians overestimated benefits of a test and underemphasized potential harms. Fourth, physicians were resistant to change when patients appeared to be doing well. Conclusions Though physicians expressed awareness to avoid overuse, deference to patient preferences and the tendency to distort the chance of benefit over harm influenced decisions to order testing. Approaches for decreasing unnecessary testing must account for perceived patient preferences, make the potential harms of overtesting salient, and address clinical inertia among patients who appear to be doing well.
- Published
- 2021