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

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  • Tritter, Jonathan Q.
  • Lutfey, Karen
  • McKinlay, John

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.

Suggested Citation

  • Tritter, Jonathan Q. & Lutfey, Karen & McKinlay, John, 2014. "What are tests for? The implications of stuttering steps along the US patient pathway," Social Science & Medicine, Elsevier, vol. 107(C), pages 37-43.
  • Handle: RePEc:eee:socmed:v:107:y:2014:i:c:p:37-43
    DOI: 10.1016/j.socscimed.2014.02.012
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    References listed on IDEAS

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    1. Isabelle Huault & V. Perret & S. Charreire-Petit, 2007. "Management," Post-Print halshs-00337676, HAL.
    2. McClellan, Mark & Cutler, David & Newhous, Joseph P., 2000. "How Does Managed Care Do It?," Scholarly Articles 2643884, Harvard University Department of Economics.
    3. Lutfey, Karen E. & Link, Carol L. & Grant, Richard W. & Marceau, Lisa D. & McKinlay, John B., 2009. "Is certainty more important than diagnosis for understanding race and gender disparities?: An experiment using coronary heart disease and depression case vignettes," Health Policy, Elsevier, vol. 89(3), pages 279-287, March.
    4. Michael L. DeKay & David A. Asch, 1998. "Is the Defensive Use of Diagnostic Tests Good for Patients, or Bad?," Medical Decision Making, , vol. 18(1), pages 19-28, January.
    5. McGivern, Gerry & Fischer, Michael D., 2012. "Reactivity and reactions to regulatory transparency in medicine, psychotherapy and counselling," Social Science & Medicine, Elsevier, vol. 74(3), pages 289-296.
    6. Lee, Yin-Yang & Lin, Julia L., 2010. "Do patient autonomy preferences matter? Linking patient-centered care to patient-physician relationships and health outcomes," Social Science & Medicine, Elsevier, vol. 71(10), pages 1811-1818, November.
    7. Matt T. Bianchi & Brian M. Alexander & Sydney S. Cash, 2009. "Incorporating Uncertainty Into Medical Decision Making: An Approach to Unexpected Test Results," Medical Decision Making, , vol. 29(1), pages 116-124, January.
    8. Paul Clay Sorum & Junseop Shim & Gérard Chasseigne & Sylvie Bonnin-Scaon & Joël Cogneau & Etienne Mullet, 2003. "Why do Primary Care Physicians in the United States and France Order Prostate-Specific Antigen Tests for Asymptomatic Patients?," Medical Decision Making, , vol. 23(4), pages 301-313, July.
    9. David M. Cutler & Mark McClellan & Joseph P. Newhouse, 2000. "How Does Managed Care Do It?," RAND Journal of Economics, The RAND Corporation, vol. 31(3), pages 526-548, Autumn.
    10. repec:mpr:mprres:3550 is not listed on IDEAS
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    Cited by:

    1. Gage-Bouchard, Elizabeth A., 2017. "Social support, flexible resources, and health care navigation," Social Science & Medicine, Elsevier, vol. 190(C), pages 111-118.

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