Patients Often Don’t Agree With Their Doctor As To What Constitutes A Low-Value Test Interview with:

Lisa Soleymani Lehmann, MD, PhD Associate Professor of Medicine and Medical Ethics Director, Center for Bioethics, Brigham and Women's Hospital Harvard Medical School Boston, Massachusetts

Dr. Lisa Lehmann

Lisa Soleymani Lehmann, MD, PhD
Associate Professor of Medicine and Medical Ethics
Director, Center for Bioethics
Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts What is the background for this study?

Response: The background for this study is the Choosing Wisely Campaign from the American Board of Internal Medicine (ABIM). This campaign has asked specialty boards to come up with lists of interventions (e.g., imaging, medications, tests) that patients and doctors should question. When it initially came out, we thought it was a great idea, but wondered if patients and doctors would agree that some of the interventions are low value. It’s hard to cut back on things that patients feel are valuable to their care, especially as patient ratings of their doctor’s care become part of hospital ratings and physician reimbursement. What are the main findings?

Response: The main findings are that for two common scenarios: patients with an uncomplicated headache and patients with upper respiratory tract infections (URIs), patients and doctors don’t agree on what is low-value care. However, if doctors give patients more information about why imaging for an uncomplicated headache, or antibiotics for a URI, are low-value and therefore not appropriate initial treatments, patients are more likely to agree. What should readers take away from your report?

Response: When patients request unwarranted treatments such as antibiotics for a URI, physicians should share their reasons for not complying with the request by referencing the best evidence and guidelines. By referencing a guideline, doctors are able to demonstrate their decision-making and show that rather than denying treatment they are practicing based on established guidelines and best evidence. What recommendations do you have for future research as a result of this study?

Response: Moving forward, I think that we have to do more research to understand how to incorporate patient preferences into clinical guidelines. The goal of guidelines is help direct clinical decision making, but that decision making involves the patient and the physician, while the guidelines are often only directed at the physician. I think Choosing Wisely is trying to bridge this gap, but there is still more work to be done. Thank you for your contribution to the community.


Warner A, Shah N, Morse A, et al. Patient and Physician Attitudes Toward Low-Value Diagnostic Tests. JAMA Intern Med.Published online June 27, 2016. doi:10.1001/jamainternmed.2016.2936.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on July 10, 2016 by Marie Benz MD FAAD