Effect of restraints on diagnostic approaches to abdominal pain and weight loss

To examine the effects of restraint on the diagnostic process, 25 physicians were urged to be as economical as possible when requesting diagnostic tests for case report simulations of nine patients who had previously been hospitalized with abdominal pain and weight loss. The results of the tests correctly changed the physicians' initial diagnoses, increased their diagnostic confidence, and led to appropriate management decisions. When restrained, individual physicians needed only 3.0 (1.7 to 4.1) diagnostic procedures per patient to reach management decisions, whereas 6.1 (3.0 to 11) diagnostic procedures had actually been performed. Diagnostic approaches were so diverse, however, that the number of procedures collectively requested by randomly assembled "teams" consisting of four to five "economical" physicians equaled the number of procedures actually performed. Moreover, 20 percent of the procedures requested by "economical" physicians were invasive compared with only 7 percent of those actually performed. These findings suggest that, without uniform diagnostic approaches, "team" management may increase testing despite restraint by individual physicians. Moreover, quests for economy may increase invasive diagnostic testing.