Physicians' professional identities: a roadmap to understanding "value" in cardiovascular imaging

Area of Science:

• Medical Imaging
• Quality Improvement
• Healthcare Policy

Background:

• Quality improvement in cardiovascular imaging faces challenges due to limited adoption of initiatives.
• Understanding these limitations requires characterizing clinical values associated with cardiovascular imaging.

Purpose of the Study:

• To characterize the range of clinical values related to cardiovascular imaging.
• To inform future quality improvement efforts by understanding physician perspectives.

Main Methods:

• 15 physicians from various specialties were interviewed about cardiovascular imaging use and guidelines.
• Interview transcripts were analyzed using constructivist grounded theory.
• A model of specialty-specific values was developed and applied, with results assessed for reproducibility.

Main Results:

• Physician perceptions of cardiovascular imaging value and guideline use varied significantly by specialty.
• Three value-associated identity categories (managers, diagnosticians, fixers) explained these differences.
• Differences were further characterized by thinking styles, answer-seeking preferences, and public visibility.

Conclusions:

• Quality improvement in cardiovascular imaging is hindered by a failure to incorporate the complexity of medical culture.
• Understanding diverse stakeholder perceptions of value, quality, and appropriateness is crucial for policy development and implementation.