Why clinicians overtest: development of a thematic framework.

Area of Science:

• Medical decision-making
• Healthcare quality improvement
• Clinical pathology

Background:

• Medical tests are crucial for patient management but overtesting leads to misdiagnosis and increased healthcare costs.
• Clinicians play a vital role in preventing unnecessary test requests and their adverse outcomes.

Purpose of the Study:

• To identify and categorize factors influencing clinicians' requests for non-recommended and unnecessary medical tests.
• To develop a thematic framework for understanding clinician test ordering behavior.

Main Methods:

• A narrative literature review of articles on clinician test ordering behavior was conducted.
• Systematic searches of MedLine, citation tracking, and expert consultation identified relevant studies.
• A preliminary framework was iteratively refined through expert workshop discussions.

Main Results:

• A framework identified "Intrapersonal" factors (e.g., fear of litigation, knowledge gaps, cognitive biases), "Interpersonal" factors (e.g., patient and colleague pressure), and "Environment/context" factors (e.g., guidelines, financial incentives, time constraints, technology).
• Sixty-five articles were included in the analysis.
• The framework highlights multifaceted influences on clinician test ordering.

Conclusions:

• The developed thematic framework can enhance clinician awareness of overtesting.
• This understanding may prompt changes in clinician test request behavior.
• Future work includes developing a scale to assess clinician practices for targeted interventions.