Why do GPs perform investigations?: The medical and social agendas in arranging back X-rays

Abstract

GPs' reported medical criteria for arranging back X-rays are mainly 'appropriate', but psychosocial reasons-especially patient satisfaction and reassurance-are also likely to be important factors. If psycho-social agendas are important in ordering investigations, then clinical guidelines which discuss only medical criteria may not be effective in reducing 'inappropriate' investigations.

Medically unexplained symptoms, somatisation disorder and hypochondriasis: Course and prognosis. A systematic review

“…A possible explanation for this finding might be the procedure as required for inclusion in the study cohorts. This procedure is an extensive clinical assessment consisting of diagnostic interviews and additional testing and might in itself be of therapeutic importance [50,51].…”

Doctors With a Special Interest in Back Pain Have Poorer Knowledge About How to Treat Back Pain

“…4 In part, this may reflect physician knowledge and beliefs, 1 although physician behavior may be influenced by many factors including patient expectation and other psychosocial factors. [5][6][7][8] Systematic reviews of trials of interventions to improve professional practice have shown that passive strategies such as providing access to medical education materials alone are ineffective. 9 -11 Most other strategies are effective under some conditions, but none are effective in all situations, suggesting that the local setting is also an important consideration.…”

A review identifies and classifies reasons for ordering diagnostic tests

“…In primary care tests are more commonly used to rule out a condition or to help the doctor to make a decision about referral, or provide further information on the patient to a secondary care specialist [5,20,32]. Another decision that primary care doctors commonly face is whether to order a test or to adopt a period of ''watchful waiting,'' asking a patient to return to see how his or her symptoms develop [39].…”

“…Patient preference, either to undergo or not undergo testing or for one test over another, can influence test ordering [3,5,13,17,20,30]. The acceptability of the test to the patient, for example in terms of invasiveness or side effects, and the impact of the potential diagnosis on the patient may affect a doctor's decision to order a test [30].…”

“…The consequences of test results, in terms of false positive and false negative results as well as accurate results, should also be considered [17]. Doctors may decide to order a test to reassure the patient that he or she is not suffering from a more severe condition, for example ordering a scan in a patient with headache to reassure him or her that he or she does not have a brain tumor [1,20,30]. A number of studies have found that test ordering is related to patient demographics with, for example, older patients or female patients receiving a disproportionate number of tests [6,9,38].…”