In a Department of Veterans Affairs (VA) medical center, use of myocardial perfusion imaging was inappropriate in approximately 20% of studies, a proportion that is similar to that reported from other practice settings in the United States. The facts that VA physicians are salaried and malpractice claims are very uncommon suggest that there are other reasons that physicians order inappropriate tests. These might include exaggerated belief in the accuracy and clinical benefit of tests, lack of understanding of the potential harms (including radiation exposure and false-positive results), and a cultural value for “doing more.” This study was small and conducted at a single VA medical center, so the findings should be viewed as hypothesis generating. Nevertheless, it suggests that the culture of overordering is ingrained and we need to carefully consider approaches to reducing inappropriate care that focus on physician knowledge and culture.
Grady D. Why Physicians Order Tests. JAMA Intern Med. 2013;173(14):1383. doi:10.1001/jamainternmed.2013.959