Abstract
Objective: To obtain first-hand in-depth accounts of overtesting amongst GPs in Norway, as well as the GPs’ perspectives on drivers of overtesting and strategies that can prevent overtesting.Design and setting: Four focus groups with GPs were conducted. All participants were asked to share examples of unnecessary testing from their everyday general practice, to identify the driving forces involved in these examples and discuss any measures that might prevent excessive testing. All authors collaborated on the analysis, conducted as systematic text condensation, using critical incident technique.Results: This study reveals two main positions regarding overtesting in general practice. In the categorical position there is no such thing as overtesting and GPs are obliged to perform extensive investigations on the suspicion that any person can carry a fatal disease, no matter how minor or absent their symptoms are. In contrast, in the dilemmatic position, the GPs acknowledge that investigations can cause significant harm, but still feel pressured to discover disease at the earliest opportunity and to meet patients’ demands. The GPs’ strategies for resolving this dilemma are often demanding and not always successful, but sharing uncertainty and fallibility with patients and colleagues appears to be the most promising strategy.Conclusions: Our study indicates that GPs in Norway experience a strong pressure to discover any instance of disease and to meet patients’ demands for investigations. One way of preventing the harm that accrues from overtesting is openly sharing uncertainty and fallibility with patients and colleagues.
Highlights
There is a growing awareness of medical overuse amongst governments, service providers, research centres and clinical experts throughout the world
Guidelines and principles that derive from the specialist paradigm are among the drivers of medical overuse, and some authors have called for a bolstering of the generalist expertise of general practitioners (GPs) to curb overuse [4]
In this study we have looked at the aspect of medical overuse that involves overtesting among Norwegian GPs
Summary
There is a growing awareness of medical overuse amongst governments, service providers, research centres and clinical experts throughout the world. For the purpose of this paper, medical overuse is broadly defined as ‘the provision of medical services for which the potential for harm exceeds the potential for benefit’ [1], and occurs in the form of overtesting and overtreatment [2]. Medical overuse is known to occur in all parts of the world and in all domains of medicine, often resulting in waste and harm, and is correlated with underuse, i.e. people who need medical care not receiving adequate help [3]. Guidelines and principles that derive from the specialist paradigm are among the drivers of medical overuse, and some authors have called for a bolstering of the generalist expertise of general practitioners (GPs) to curb overuse [4]. Medical overuse has in recent years been high on the agenda of The Norwegian College of General Practice and in 2016 the college published a position paper on medical overuse [6]
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