Patients rarely request clinically inappropriate tests
Fewer than 1 percent of encounters between clinicians and patients led to a request for medical services that were deemed clinically inappropriate, according to a study published online in JAMA Oncology, which examined oncology outpatient facilities at three Philadelphia-area hospitals between October 2013 and June 2014.
The researchers noted that physicians complain the influx of medical information on the Internet has contributed to patients demanding tests and procedures and to higher healthcare costs. They also said that physicians might feel obligated to listen to the patients even in inappropriate situations because their compensation is tied to patient satisfaction and they fear patients will switch to another doctor. They cited a study that found between 40 percent and 66 percent of physicians have received patient demands or requests for tests or treatments, while 25 percent to 53 percent complied with at least one request.
In this study, researchers interviewed 60 clinicians in oncology practices at the Hospital of the University of Pennsylvania, Presbyterian Hospital and Pennsylvania Hospital. The study included 34 oncologists, 11 oncology fellows and 15 nurse practitioners and physician assistants. Of the patients, 58.7 percent were female and 69.4 percent were white.
Research assistants interviewed the clinicians after leaving the examination room or at the end of a half-day clinic session and recorded their answers using software installed on an iPad. They asked the clinicians if patients requested or demanded a specific test or treatment. If they said yes, they were then asked to rate the appropriateness of the test or treatment on a scale of 1 (not appropriate) to 10 (extremely appropriate) and whether they ordered the test or treatment and to provide reasons why.
Of the 5,050 clinician encounters that involved 3,624 cancer patients, only 8.7 percent included patient requests for a medical service. Physicians said most of the requests were appropriate. In 96 percent of the cases, the patient initiated the request. The remaining four percent were from a friend, family member or another clinician.
Of the 50 demands or requests deemed clinically inappropriate, 18 were for imaging studies, eight were for laboratory tests such as tumor markers, nine were for chemosensitivity assays, two were for proton beam therapy, two were for chemotherapy, two were for clinical trials, one was for palliative care, and eight were for other interventions, including intravenous fluids and shingles vaccine.
The researchers said this study had a few limitations, including that the results may not be generalizable to geographic regions outside of Philadelphia or in other practice settings or in primary care specialties. They also mentioned a high percentage of patients had private health insurance and came from higher-income zip codes. In addition, the clinicians identified whether the demand or request for a test or service was appropriate, but they could have erred in their opinion and conclusion.
Executive Editor
Tim Casey joined TriMed Media Group in 2015 as Executive Editor. For the previous four years, he worked as an editor and writer for HMP Communications, primarily focused on covering managed care issues and reporting from medical and health care conferences. He was also a staff reporter at the Sacramento Bee for more than four years covering professional, college and high school sports. He earned his undergraduate degree in psychology from the University of Notre Dame and his MBA degree from Georgetown University.