97% of ED Physicians Order Unnecessary Imaging Tests

John Commins, March 30, 2015

The fact that nine out of 10 emergency physicians admit to ordering medically unnecessary tests indicates that existing protocols and safeguards to prevent overuse clearly aren't working, survey results suggests.

Nearly all of the 435 emergency physicians in a recent survey admitted to ordering too many diagnostic tests, but said they did so out of fear of error, uncertainty, and non-medical reasons.

The survey, published this month in Academic Emergency Medicine, focused specifically on the use, and over-use, of imaging tests. More than 85% of the respondents said they believe that too many tests are ordered in their own departments, and 97% admitted they ordered "medically unnecessary" radiology tests, which were defined as imaging the physician ordered in response to external pressures and not for optimal medical care.

"I am not surprised by the findings," says Hemal Kanzaria, MD, the lead author of the study, and an emergency physician practicing at UCLA Ronald Reagan Medical Center, and VA West Los Angeles Medical Center. "I face these issues every time I work in the emergency department and I agree with the collective response from my colleagues that there are many aspects of the practice environment that drive over-diagnoses."

"A lot of what I heard from our survey respondents regarding a fear of being wrong, or missing a low-probability, but potentially life-threatening diagnosis resonates with my own clinical practice, says Kanzaria, who is also a clinical scholar with the Robert Wood Johnson Foundation, which funded the study with the Department of Veterans Affairs.

The fact that nearly every emergency physician admits to ordering medically unnecessary tests indicates that existing protocols and safeguards to prevent overuse clearly aren't working, survey results suggests.

"Overall, I interpret our results to suggest that over-testing is not due to physicians' lack of knowledge or lack of insight or poor medical judgment, but reflects a cultural response both within and outside medicine to uncertainty and error," Kanzaria says.

"I personally think that to overcome over-testing we need to address our collective intolerance of uncertainty both within medicine and within society at large as well as this culture of blame that triggers the malpractice system."

John Commins

John Commins is a senior editor at HealthLeaders Media.

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