Healthy Skepticism Library item: 19028

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Publication type: Journal Article

Herndon MB, Schwartz LM, Woloshin S, Anthony D, Gallagher P, Fowler FJ, Fisher E.
Older patients perceptions of 'unnecessary' tests and referrals: a national survey of Medicare beneficiaries.
J Gen Intern Med 2008; 23:(10):1547-54
http://www.springerlink.com/content/935q6u7727u36226/

Abstract:

CONTEXT: Unnecessary exposure to medical interventions can harm patients. Many hope that generalist physicians can limit such unnecessary exposure.

OBJECTIVE: To assess older Americans’ perceptions of the need for tests and referrals that their personal physician deemed unnecessary.

DESIGN: Telephone survey with mail follow-up in English and Spanish, conducted from May to September 2005 (overall response rate 62%).

STUDY PARTICIPANTS: Nationally representative sample of 2,847 community-dwelling Medicare beneficiaries. Main analyses focus on the 2,319 who had a personal doctor (“one you would see for a check-up or advice if you were sick”) whom they described as a generalist (“doctor who treats many different kinds of problems”).

MAIN OUTCOME MEASURE: Proportion of respondents wanting a test or referral that their generalist suggested was not necessary using 2 clinical vignettes (cough persisting 1 week after other flu symptoms; mild but definite chest pain lasting 1 week).

RESULTS: Eighty-two percent of Medicare beneficiaries had a generalist physician; almost all (97%) saw their generalist at least once in the past year. Among those with a generalist, 79% believed that it is “better for a patient to have one general doctor who manages most of their medical problems” than to have each problem cared for by a specialist. Nevertheless, when faced with new symptoms, many would want tests and referrals that their doctor did not think necessary. For a cough persisting 1 week after flu symptoms, 34% would want to see a lung specialist even if their generalist told them they “probably did not need to see a specialist but could if they wanted to.” For 1 week of mild but definite chest pain when walking up stairs, 55% would want to see a heart specialist even if their generalist did not think it necessary. In these same scenarios, even higher proportions would want diagnostic testing; 57% would want a chest x-ray for the cough, and 74% would want “special tests” for the chest pain.

CONCLUSIONS: When faced with new symptoms, many older patients report that they would want a diagnostic test or specialty referral that their generalist thought was unnecessary. Generalists striving to provide patient-centered care while at the same time limiting exposure to unnecessary medical interventions will need to address their patients’ perceptions regarding the need for these services.

Keywords:
geriatrics - patient perceptions - tests and referrals - shared decision making