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Physicians Believe Many Patients Receive Too Much Care

A survey of US primary care physicians revealed that nearly half (42%) believe that their patients receive too much medical care. Only 6% of physicians said that their patients were receiving too little care.


Lara C. Pullen, Medscape, Sep 27 , 2011

September 27, 2011 - A survey of US primary care physicians revealed that nearly half (42%) believe that their patients receive too much medical care. Only 6% of physicians said that their patients were receiving too little care. More than a quarter of physicians surveyed believe that they themselves practice medicine too aggressively.

The survey was conducted because primary care physicians are on "the frontline of health care delivery" and "are at least indirectly responsible for initiating the cascade of health care utilization (testing, therapies, and hospitalizations) for most patients," explain the researchers. It is important, therefore, to know their views to being to curb costs and reduce unnecessary medical care.

The response rate to the survey was surprisingly high, at 70%. The results were published in the September 26 issue of the Archives of Internal Medicine.

Factors that the survey respondents cited as causing them to practice more aggressively were:

  • malpractice concerns (76%),
  • clinical performance measures (52%), and
  • inadequate time to spend with patients (40%).

In the survey, physicians noted that inadequate time with patients may force physicians to turn to testing or referrals to solve clinical questions. Calvin Chou, MD, PhD, from the University of California, San Francisco, and San Francisco Veterans Affair Medical Center, provided an invited commentary in the same issue of the journal. He noted: "Implicit in these findings is a kind of trained helplessness - it seems that physicians know they are practicing aggressively but feel they have no recourse."

The survey demonstrated that physicians recognize the excesses of the current healthcare system, can identify some of the causes, and may be open to changing their own practice to address the excesses. Brenda E. Sirovich, MD, and colleagues from the VA Outcomes Group in White River Junction, Vermont, authored the study.

"Physicians believe they are paid to do more and exposed to legal punishment if they do less. Reimbursement systems should encourage longer primary care physician visits and telephone, e-mail, and nursing follow-up, rather than diagnostic intensity," they write.

The authors conclude, "Physicians are open to practicing more conservatively," but for practice to change, financial incentives must be realigned, the malpractice system must be reformed, and physicians must be allowed more time with their patients.

This study was supported by a Veterans Affairs Merit Review grant and by a grant from the National Institute of Aging. The authors and Dr. Chou have disclosed no relevant financial relationships.

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