Over utilization of diagnostic testing has been ascribed to either a profit motive on the part of physicians or fear of malpractice claims. While there is no discounting either, a new study shows that the VA has a similar problem. The VA physicians/nurses of course have no profit motive and liability is extremely rare because most claims are resolved through an administrative process. Authors in this JAMA paper reviewed 332 myocardial perfusion tests in 2010 and 2011 and using well published criteria for ordering the test , 13% were considered inappropriate and another 8% uncertain. The findings were no different than previous reports from non-VA institutions suggesting other factors rather than just profit motives or fear of lawsuits were in play.
Comment:Part of this behavior may be due to the training physicians received as well as an exaggerated perception of benefit for asymptomatic patients as the authors point out. News media are always quick to point out the profit motive as the answer to everything to do with physician behavior so I wonder how this will be reported. Maybe minimize the lawsuit risk and not mention the emotional toll on physicians?