Abstract
Background
Variation in clinicians’ diagnostic test utilization is incompletely explained by
demographics and likely relates to cognitive characteristics. We explored clinician
factors associated with diagnostic test utilization.
Methods
We used a self-administered survey of attitudes, cognitive characteristics, and reported
likelihood of test ordering in common scenarios; frequency of lipid and liver testing
in patients on statin therapy. Participants were 552 primary care physicians, nurse
practitioners, and physician assistants from practices in 8 US states across 3 regions,
from June 1, 2018 to November 26, 2019. We measured Testing Likelihood Score: the
mean of 4 responses to testing frequency and self-reported testing frequency in patients
on statins.
Results
Respondents were 52.4% residents, 36.6% attendings, and 11.0% nurse practitioners/physician
assistants; most were white (53.6%) or Asian (25.5%). Median age was 32 years; 53.1%
were female. Participants reported ordering tests for a median of 20% (stress tests)
to 90% (mammograms) of patients; Testing Likelihood Scores varied widely (median 54%,
interquartile range 43%-69%). Higher scores were associated with geography, training
type, low numeracy, high malpractice fear, high medical maximizer score, high stress
from uncertainty, high concern about bad outcomes, and low acknowledgment of medical
uncertainty. More frequent testing of lipids and liver tests was associated with low
numeracy, high medical maximizer score, high malpractice fear, and low acknowledgment
of uncertainty.
Conclusions
Clinician variation in testing was common, with more aggressive testing consistently
associated with low numeracy, being a medical maximizer, and low acknowledgment of
uncertainty. Efforts to reduce undue variations in testing should consider clinician
cognitive drivers.
Keywords
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Article Info
Publication History
Published online: March 17, 2022
Footnotes
Funding: This project was funded by National Institutes of Health National Library of Mediciine DP2LM012890 (New Innovator Award) to principal investigator DJM. The funder had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Conflicts of Interest: DK's work on this project was supported in part by a Cancer Center Support Grant from the National Cancer Institute to Memorial Sloan Kettering Cancer Center (P30 CA008748). CDF reports serving as the local site investigator for a Pfizer-sponsored Clostridioides difficile vaccine trial (protocol #B5091007) since July 2020 under a Cooperative Research and Development Agreement (CRADA) to VA Portland. DK discloses that her spouse serves on the scientific advisory board of Vedanta Biosciences and has equity interest, serves on the scientific advisory board of PFL-NYC, and provides consulting for Fimbrion. All other authors declare no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work.
Authorship: DK, DM, and LP planned the study; all authors contributed to survey development. LP, DS, and DM conducted the study. LM and AL designed and performed the analysis. DK drafted the manuscript and all authors contributed to revisions. DK and DM are the guarantors. DK attests that all listed authors had access to the data and a role in writing the manuscript.
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