Physician thoughts on unnecessary noninvasive imaging and decision support software: A qualitative study

Abstract

Objective Gather information from physicians about factors contributing to unnecessary noninvasive imaging and impact of possible solutions. Methods Qualitative study of 14 physicians using a phenomenological approach and the Theoretical Domains Framework. Results Most participants ( n = 9) self-reported that >10% of the imaging tests they order are unnecessary. External sources of pressure included: peer-review, patient demands, nursing expectations, specialist requests (social demands), as well as prior experience with patient advocates, and the compensation and pension system (environmental context). Internal sources of pressure included reliance on anecdote (emotion), self-doubt about diagnoses (beliefs about capabilities), and fear of missing a diagnosis and of professional liability (beliefs about consequences). Participants expressed both optimism and concern about potential solutions, such as adopting decision support software. Conclusion Physicians are under pressure from multiple sources to order unnecessary imaging. Peer review, nursing expectations, and perceptions about Veteran compensation and pension are newly reported contributing factors.