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Many Doctors Think Patients Get Over-Treated, Study Says
Date:9/26/2011

e, while 29 percent felt other primary care physicians in their community were practicing too aggressively.

Almost all said they believed that primary care physicians vary in patient testing and treatment, and three-quarters were interested in learning how their own practice compared to others.

Malpractice concerns drive many decisions to treat aggressively, the doctors said. More than 80 percent felt they could easily be sued for failing to order a test that was indicated, while 21 percent felt they could be sued for ordering a test that wasn't. Having too little time with patients was cited by 40 percent as another reason for aggressive treatment.

"The whole survey is based on their opinions and perceptions, and that's really what we were going after," Sirovich said. "Of course, there are limitations inherent in asking physicians what they themselves do . . . among them may be the natural desire to be viewed favorably, which is why we also asked about other physicians -- which of course is speculative. That's the nature of the design of the study."

While few doctors said they order expensive treatments to boost their own income, nearly two-thirds suggested that other doctors might do so.

In a commentary published with the study, Dr. Calvin Chou, a professor of medicine at the University of California, San Francisco, said the findings imply a "trained helplessness" among physicians since they know they are practicing aggressively but feel they have no recourse.

"I would say most doctors probably feel somewhat helpless when they're expected to practice defensive medicine and check off a whole bunch of boxes," said Chou, also a general internist at San Francisco Veterans Affairs Medical Center. "I think when you're running scared all the time and have a whole bunch of boxes to check . . . more and more doctors feel like they're under the gun and are less likely to be able to rise above it. I think it's possible, but it requires
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