In a national survey published in Academic Emergency Medicine, 97% of the 435 emergency physicians (EPs) that responded acknowledged sometimes ordering advanced diagnostic imaging procedures, i.e. computed tomography (CT) and magnetic resonance imaging (MRI), they considered superfluous. The authors of the study state that overimaging “may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary.” Unnecessary CT scans expose patients to extra doses of radiation that may ultimately be detrimental to their health. The survey also asked respondents to cite factors they believe are contributing to the issue as well as potential solutions.
Reasons for overordering
- Fear of missing even a low-probability diagnosis (68.9%)
- Malpractice concerns (64.3%)
- Patient/family expectations (39.7%)
- Standard practice norms for their group/close colleagues (38.5%)
- Standard emergency medicine practice (34.9%)
- Time saving (23.6%)
- Administrative pressure to increase group reimbursement (1.4%)
- Increasing personal reimbursement (0.7%)
Potential solutions
- Malpractice reform to counteract the need for defensive medicine (78.9%)
- Increased patient involvement through education (69.9%)
- Shared decision-making about tests (55.9%)
- Feedback to physicians on their test-ordering metrics vs. peers’ (54.8%)
- Improved physician education on diagnostic testing (50.2%)
- Better staffing to boost clinical evaluation (39.7%)
- Voluntary guidelines on when to order tests (37.9%)
- Elimination of financial incentives to order tests (32.7%)
- Computer decision support on testing for clinicians (25.2%)
- Financial incentives to physicians to order fewer tests (17.5%)
- Encourage societal change away from a perceived “no-miss” attitude (most common write-in answer)