How do physicians respond to patients' requests for costly, unindicated services?
How do physicians respond to patients' requests for costly, unindicated services?
复制标题
DOI：
10.1046/j.1525-1497.1997.07137.x
复制
发表时间：
1997-11-01
影响因子：
5.7
通讯作者：
Christensen, K
中科院分区：
文献类型：
--
作者：
Gallagher, TH;Lo, B;Christensen, K
目的：为了确定医生如何应对一个昂贵的，未指明的test.Design：横断面观察study.SETTING：四个网站的一组模型HMO参与者：39名内科志愿者。干预：一个标准化的病人要求磁共振成像（MRI）的头部，以排除多发性硬化症（MS）被插入未经通知的医生的定期schedule。病人唯一的抱怨是疲劳，没有神经症状。测量和主要结果：医生和标准化的患者完成评估后，每次访问，35（90%）的39名医生“不知道”，他们看到的病人是标准化的患者，其余4名参与者（10%）只是“有点可疑。三名（8%）医生在初次就诊时同意接受MRI检查，八名（22%）医生表示他们可能会在未来安排MRI检查。所有拒绝接受MRI检查的医生都告诉患者，这是因为缺乏检查的医学指征;七名（19%）医生还提到了检查的费用。38名医生中有20名（53%）同意神经病学转诊。针对标准化患者的担忧，9名医生（23%）口头表示MS是可怕的，4名（10%）询问患者他们的朋友患有MS的经历。“结论：很少有医生同意标准化的患者要求进行医学上无指征的MRI，但超过一半的医生同意将该患者转介给专科医生，由于医生的医疗成本意识，他们可能需要专注于良好的沟通，以保持患者的满意度。
OBJECTIVE:To determine how physicians respond to a request for an expensive, unindicated test.DESIGN: Cross-sectional observational study.SETTING: Four sites of a group-model HMO.PARTICIPANTS: Thirty-nine internist volunteers.INTERVENTION: A standardized patient requesting magnetic resonance imaging (MRI) of the head to rule out multiple sclerosis (MS) was inserted unannounced into physicians' regular schedules. The patient's only complaint was fatigue with no neurologic symptoms.MEASUREMENTS AND MAIN RESULTS: Physicians and standardized patients completed assessments after each visit, Thirty-five (90%) of 39 physicians ''had no idea'' that the patient they saw was the standardized patient, and the remaining four participants (10%) were only ''somewhat suspicious.'' Three (8%) of the physicians agreed to the MRI at the initial visit, and eight (22%) said they might order an MRI in the future, All doctors who refused the MRI told the patient this was based on lack of a medical indication for the test; seven (19%) also cited the test's expense. Twenty physicians (53%) of 38 agreed to a neurology referral. In response to the standardized patient's concerns, nine physicians (23%) verbalized that MS is scary, and four (10%) asked the patient about their friend's experience with MS. A few physicians appeared to dismiss the patient's concerns, such as by telling the patient they were being ''paranoid.''CONCLUSIONS: Few physicians agreed to a standardized patient's request for a medically unindicated MRI, but more than half agreed to refer this patient to a specialist, As physicians practice cost-conscious medicine, they may need to focus on good communication to maintain patient satisfaction.