Physician choices in pulmonary embolism testing

Mapping emergency physician reasoning for adhering to evidence‐based pulmonary embolism testing

“…Instead, lack of adherence to evidence‐based practice seemed to be influenced by nagging doubts, anecdote, severity of the patient illness, fear of missing PE and a “feeling.” All of these components contributed to a Gestalt estimate that the patient could have underlying PE, despite evidence to the contrary. A developing body of evidence supports these findings of fear of missing PE 6,9 and use of Gestalt 6,9,10 as central drivers in deviating from evidence‐based PE testing in the ED.…”

Patient values and preferences in pulmonary embolism testing in the emergency department

“…[4][5][6] These findings are at odds to the emergency physician's perception of their role. Emergency physicians define themselves as experts who quickly spot dangerous conditions, 11,17 rather than physicians who counsel patients why they do not need a chest scan or who explain potential causes of chest pain when no physical diagnosis can be made. Most evidence-based diagnostic advances have focused on reducing imaging use in the ED, with movements such as Choosing Wisely encouraging physicians to limit advanced testing to a subset of patients who will benefit from it (for example restricting CT pulmonary angiography to those with a high Wells score or positive D-dimer).…”

“…[8][9][10] On one hand, a recent study found that patient expectation of undergoing diagnostic imaging was a barrier to using safe rule-out tests for PE, such as the Wells score and D-dimer. 11 However, on the other hand, there is evidence that some patients might decline CT scanning for PE when their physicians use standardized information sharing tools on the risks and benefits of CT. 12 A better understanding of patient priorities for PE testing is a first step to developing PE testing algorithms which incorporate both evidence and patient-centered values. The aim of this study was to identify patient expectations, values, and preferences regarding PE testing in the ED to inform future methods of achieving more patient-centered care.…”

“…Sometimes, evidence‐based guidelines on testing for pulmonary embolism (PE) are not followed by emergency physicians 8‐10 . On one hand, a recent study found that patient expectation of undergoing diagnostic imaging was a barrier to using safe rule‐out tests for PE, such as the Wells score and D‐dimer 11 . However, on the other hand, there is evidence that some patients might decline CT scanning for PE when their physicians use standardized information sharing tools on the risks and benefits of CT 12 .…”

Do physicians contribute to psychological distress after venous thrombosis?

“…Fear of pulmonary embolism is pervasive among physician culture. 6 Most emergency physicians will manage a patient with acute pulmonary embolism only once every few months and may rely on a pulmonary embolism response team to determine acute management. In this study, patients recall sudden changes in provider behavior once the diagnosis is known: closer monitoring, additional physicians, and a more serious demeanor.…”