Clinician Attitudes and Beliefs Associated with More Aggressive Diagnostic Testing

Area of Science:

• Medical Practice
• Health Services Research
• Clinical Decision Making

Background:

• Diagnostic test utilization by clinicians shows significant variation.
• This variation is not fully explained by patient demographics.
• Cognitive characteristics of clinicians likely play a substantial role.

Purpose of the Study:

• To explore clinician-specific factors associated with diagnostic test utilization.
• To identify cognitive and attitudinal drivers of testing frequency.

Main Methods:

• A self-administered survey assessed attitudes, cognitive traits, and reported test ordering likelihood.
• Data collected from 552 primary care clinicians (physicians, nurse practitioners, physician assistants) across 8 US states.
• Key metrics included a Testing Likelihood Score and reported frequency of lipid/liver testing in patients on statins.

Main Results:

• Testing Likelihood Scores varied significantly among clinicians (median 54%, IQR 43%-69%).
• Higher testing likelihood correlated with low numeracy, high fear of malpractice, high "medical maximizer" scores, high stress from uncertainty, and low acknowledgment of medical uncertainty.
• Frequent lipid and liver testing was linked to low numeracy, high "medical maximizer" scores, high malpractice fear, and low uncertainty acknowledgment.

Conclusions:

• Significant variation exists in clinician diagnostic testing practices.
• Cognitive factors such as low numeracy, being a "medical maximizer," and low acknowledgment of uncertainty are consistently associated with more aggressive testing.
• Interventions to standardize testing should target these underlying cognitive drivers to reduce unwarranted variations.