Low-Value Clinical Practices: Knowledge and Beliefs of Spanish Surgeons and Anesthetists

Abstract

OBJECTIVES: To know the frequency and causes of low value surgical practices, according to the opinion of surgeons and anesthetists, and to determine their degree of knowledge about the Spanish "Choosing wisely" initiative. METHODS: Cross-sectional observational study, based on a self-administered online questionnaire through an opportunistic sample of 370 surgeons and anesthetists from three Spanish regions, contacted through Scientific Societies. The survey took part between July and December 2017. RESULTS: A patient profile requesting unnecessary practices was identified (female, 51-65 years old and unaffiliated disease). The frequency of requests was weekly or daily for 50.0% of the professionals, of whom 15.1% acknowledged succumbing to these pressures. To dissuade the patient, clinical reasons (47%) were considered the most effective. To increase control and safety in the case was the main reason to indicate them. The greatest responsibility for overuse was attributed to physicians, defensive medicine and mass media. Assessing professionals' knowledge on unnecessary practices, an average of 5 correct answers out of 7 was obtained. Some 64.1% of the respondents were unaware of the Spanish "Choosing wisely" initiative. CONCLUSIONS: Low value surgical practices are perceived as a frequent problem, which requires an approach entailing intervention with patients and the media as well as professionals. Increase awareness on unnecessary surgical practices, and how to avoid them remain essential.

Keywords: anesthesia; medical overuse; surgery; unnecessary procedures.

Figure 1

Main reasons why the professionals indicated unnecessary clinical procedures. Percentage of professionals who indicated each reason (including the 95% confidence intervals for each estimation).

Figure 2

Degree of responsibility regarding overuse referred, according to the professional’s gender and work experience. Scale from 0 to 10, where 0 means “No responsibility” and 10 “Maximum responsibility” (with the expected 95% confidence interval of such percentages). * p < 0.050; ** p < 0.001.

Figure 3

Frequency of patients’ unnecessary procedures requested to surgical doctors, according to the gender and experience of professionals. Percentage of professionals who indicated each reason (with the 95% confidence interval of such percentages). Each respondent could mark as many procedures deemed necessary. ‡: “Surgical treatment”, “digestive tumor markers”, “genetic studies”, “cesarean sections”, “lactose intolerance test”, “electrotherapy and thermotherapy”, “allergy tests”, and” electromyography”. * p < 0.050; ** p < 0.001.

Figure 4

Arguments considered “highly effective” or “very highly effective” to persuade the patient about the inadequacy of medical procedures. Percentage of professionals who indicated each reason (with the expected 95% confidence interval of such percentages).