What are tests for? The implications of stuttering steps along the patient pathway

Jonathan Q. Tritter*, Karen Lutfey, John McKinlay

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

This article explores the implications of how US family physicians make decisions about ordering diagnostic tests for their patients. Data is based on a study of 256 physicians interviewed after viewing a video vignette of a presenting patient. The qualitative analysis of 778 statements relating to trustworthiness of evidence for their decision making, the use of any kind of technology and diagnostic testing suggests a range of internal and external constraints on physician decision making. Test-ordering for family physicians in the United States is significantly influenced by both hidden cognitive processes related to the physician's calculation of patient resources and a health insurance system that requires certain types of evidence in order to permit further tests or particular interventions. The consequence of the need for physicians to meet multiple forms of proof that may not always relate to relevant treatment delays a diagnosis and treatment plan agreed not only by the physician and patient but also the insurance company. This results in a patient journey that is made up of stuttering steps to a confirmed diagnosis and treatment undermining patient-centred practice, compromising patient care, constraining physician autonomy and creating additional expense. © 2014 Elsevier Ltd.

Original languageEnglish
Pages (from-to)37-43
Number of pages7
JournalSocial science and medicine
Volume107
DOIs
Publication statusPublished - Apr 2014

Fingerprint

Stuttering
physician
Physicians
family physician
Family Physicians
Decision Making
diagnostic
decision making
insurance company
trustworthiness
Health Insurance
Insurance
Routine Diagnostic Tests
health insurance
patient care
evidence
Pathway
Patient Care
Therapeutics
video

Keywords

  • diagnostic testing
  • evidence based medicine
  • health insurance
  • patient-centred care
  • physician autonomy
  • uncertainty
  • United States

Cite this

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What are tests for? The implications of stuttering steps along the patient pathway. / Tritter, Jonathan Q.; Lutfey, Karen; McKinlay, John.

In: Social science and medicine, Vol. 107, 04.2014, p. 37-43.

Research output: Contribution to journalArticle

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