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Clinicians Ordering Inappropriate Prostate Screenings

75 years and 1,871 (0.8 percent) in patients younger than 40 years.

Of the health care clinicians who ordered inappropriate tests, 51.3 percent were male, 79.4 percent were physicians, 53.4 percent were trainee physicians and 8.2 percent were urologists.

Practitioners who were urology specialists, male, infrequent PSA tests orderers and affiliated with specific hospitals had significantly higher levels of inappropriate PSA screening. Compared with attending physicians, nurses and physician assistants had significantly lower levels of inappropriate screening, the authors write.

The percentage of inappropriate PSA screening increased significantly with the age of male health care providers, they continue.

The cause of these sex and age differences is not clear. It is possible that, as they age, male health care providers increasingly empathize with their older male patients over prostate cancer concerns. Their prostatemphathy may then lead to more aggressive screening in these older male patients.

Patient education and systems-level changes, such as a computerized system that could alert clinicians when they attempt to order an inappropriate PSA test, could help reduce the level of PSA screening misuse, the authors conclude.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org


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