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Research Letter
Less Is More
December 2018

Analysis of Diagnostic Test Ordering Habits Among Internal Medicine Residents

Author Affiliations
  • 1Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, New York
  • 2Department of Radiology, Weill Cornell Medical College, New York, New York
  • 3Division of Internal Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
JAMA Intern Med. 2018;178(12):1719-1721. doi:10.1001/jamainternmed.2018.3519

The Dartmouth Atlas of Health Care sheds light on wide variations in spending for Medicare beneficiaries in the 6 months before their death.1 That report has led to several efforts to better standardize patient care. High-value care has been defined as the seventh competency, with national efforts to educate physicians and physicians in training about how to deliver higher-quality care, while decreasing the cost of that care.2 Medical students and residents are particular targets for this effort because of the known “imprinting,” or sustained influence, that the training environment has on practice habits during a physician’s career.3 Kahneman and colleagues4 found that professionals express a much greater-than-expected degree of variability in the outcomes of their work, even when given the same data with which to base their conclusions. We are aware of 2 previous studies that showed a large degree of variability in resident patterns of test ordering. One study5 analyzed outpatient test ordering in 1987, and another,6 “practice intensity” in 2015.

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