Abstract
Previous research has found that American patients strongly believe that more testing and more treatment lead to better outcomes and, to a lesser extent, that newer treatments are more effective. We conducted five focus groups with privately insured, healthy, middle-aged Americans (n = 43) to explore these apparent preferences. Contrary to previous research, an unexpected distinction emerged. Participants placed enormous value on testing and screening, reacting with hostility to guidelines recommending less of either. However, they were suspicious of overmedication. The wariness of pharmaceuticals and enthusiasm for testing and screening both appear to reflect participants’ efforts to take responsibility for their health. But recommendations to test and screen less conflicted with their active, engaged, information-seeking roles. Nonetheless, given patients’ concerns about overuse of pharmaceuticals, we maintain that they can learn to understand the connections between over-testing and over-treatment, and can actively choose to do less. We close with suggestions about how treatment guidelines can better communicate these connections to patients. Our findings cannot necessarily be generalized beyond privately-insured, healthy, middle-aged Americans. But because we found that, among these individuals, attitudes towards pharmaceuticals differ from attitudes towards testing and screening, we maintain that future research should also distinguish among and compare attitudes towards different types of medical interventions.
Highlights
The overuse of medical interventions, including pharmaceuticals, testing, and screening, has come under scrutiny for its economic costs and potential to harm patients [1,2,3,4,5]
The trend toward patient autonomy accelerated in the 1970s and 1980s, in part because of activism by feminists and people with AIDS who were determined to control their medical care [13]
We found that participants placed enormous value on testing and screening
Summary
The overuse of medical interventions, including pharmaceuticals, testing, and screening, has come under scrutiny for its economic costs and potential to harm patients [1,2,3,4,5]. In the United States, unnecessary services cost private and public payers $210 billion in 2009, approximately 30% of all healthcare costs [6]. Drivers of overuse in the United States include fee-for-service payment structures, physicians’ fear of malpractice lawsuits, industry marketing of pharmaceuticals and devices to medical professionals, and physicians’ culture of thoroughness [8]. The American Board of Internal Medicine (ABIM) Foundation and a coalition of professional medical associations have begun to engage physicians in efforts to ‘‘choose wisely’’ among treatments and screening and testing procedures [9]. Patient choice remains constrained by physicians, payers, regulators, and industry, patient participation has become an institutionalized part of the healthcare system [16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
