According to a new survey, nearly half of primary care physicians believe that their patients are “receiving too much care;” mostly in the form of unnecessary tests and referrals to specialists. More than one-quarter of these doctors believe that they themselves are practicing too aggressively, and they tend to blame the fear of malpractice suits for their actions. Meanwhile, when asked about their colleagues; including nurse practitioners and medical sub-specialists like cardiologists, allergists, gastroenterologists, etc., the surveyed doctors indicated that financial incentives were most likely driving over-treatment.
These are just some of the intriguing findings from the survey published in this week’s Archives of Internal Medicine that involved some 600 primary care doctors who treat adults across the U.S. The authors of the report, led by Brenda E. Sirovich and colleagues at the VA Outcomes Group and Dartmouth Institute for Health Policy and Clinical Practice, consider primary care doctors “the frontline of health care delivery,” by virtue of the fact that they “both manage their own patients and are the source of most referrals to other physicians” and “are at least indirectly responsible for initiating the cascade of health care utilization (testing, therapies, and hospitalizations) for most patients.”
Utilization is at the heart of rising health care costs; any effort to “bend the cost curve” will entail reducing the estimated 30% of all care that is deemed unnecessary. Yet as defenders of this “frontline” of health care delivery, primary care doctors still seem deeply conflicted; they acknowledge that patients are receiving “too much care,” but seem confused about how best to remedy this problem.
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