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One of the favorite complaints of doctors when we confront them with the over using technology and overtreating patients is that they demand it. Do they? More and more evidence says that's a myth. This is Healthcare Triage News.

For those of you who want to read more, go here: http://theincidentaleconomist.com/wordpress/?p=61385

John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

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One of the favorite complaints of doctors when you confront them with overusing technology and overtreating patients is that they say patients demand it. Do they? More and more evidence says that's a myth. This is Healthcare Triage news.

[intro music]

Paper was just published in JAMA Oncology called, "Patient demands and requests for cancer tests and treatments." Let's discuss.

Researchers looked at more than 5,000 oncology, or cancer, encounters involving more than 3,600 patients and 60 clinicians. Just under 9% of them involved a patient demand or request for a medical intervention.

But about 83% of these "demands" were clinically appropriate. Only 11% of them were actually clinically inappropriate.

But all of these percentages of percentages miss the fact that a clinically inappropriate intervention was asked for in only about 1% of encounters.

Moreover, doctors complied with only 14% of the inappropriate demands. So in only 7 out of 5,050 encounters did a clinically inappropriate intervention get done because a patient demanded it.

Further, let's acknowledge that the vast majority of patient demands were clinically appropriate. Which begs the question as [sic] why they needed to demand them.

Let's also acknowledge that a very, very small number of inappropriate demands exist, and only a tiny percentage of them get done.

When I blogged about this, I got a lot of doctors and others on Twitter claiming that this study only showed that cancer patients weren't demanding treatment. They assumed that all of the other kinds of patients are still the reason we overtreat and over-test in medicine.

But as you may remember from the video we did on antibiotic overuse, there's a lot of research that shows that patients aren't the problem in primary care either.

There's the study published in 1999 in Pediatrics that looked at expectations and outcomes around visits to the doctor for kids with cold. Docs were more likely to write prescriptions if they thought parents wanted them, but they often guessed wrong as to what patients actually desired. Turns out that docs' prescribing behavior didn't correlate with what parents actually wanted.

There's the study published in 2003 in the Annals of Emergency Medicine, which found that docs were more likely to prescribe an antibiotic for diarrhea when they assumed that patients expected it. But they were only right about what patients expected about one-third of the time.

There's the 2007 study published in the Annals of Emergency Medicine, which found that docs were more likely to prescribe antibiotics for patients with bronchitis and such if they thought patients wanted them. But they only got the expectations right about a quarter of the time.

There's even the 2003 study published in the Journal of General Internal Medicine, which found that docs got patients' demands so wrong that they prescribed antibiotics to 29% of patients who didn't want them.

We can continue to blame patients. But the evidence I see shows that these concerns aren't real. I think that this passage from the accompanying editorial is spot on:

"The real point of the study by Gogenini et al., however, is this: we have to stop blaming patients for being demanding. In reality, it is hardly happening. The myth of the demanding patient is more about our own responses and how lackluster communication skills can contribute to difficult situations that stick in our throats and our memories. And when we have calmed down enough to look up, we see that what is really happening between patients and physicians these days is something quite different."

Or, you know, we can keep on blaming them in spite of the evidence. Which is what a lot of people on my Twitter feed seem to favor.

[outro music]