Examining primary care physician rationale for not following geriatric choosing wisely recommendations

Theresa A. Rowe*, Tiffany Brown, Jason N. Doctor, Jeffrey A. Linder, Stephen D. Persell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: The objective is to understand why physicians order tests or treatments in older adults contrary to published recommendations. Methods: Participants: Physicians above the median for ≥ 1 measures of overuse representing 3 Choosing Wisely topics. Measurements: Participants evaluated decisions in a semi-structured interview regarding: 1) Screening men aged ≥ 76 with prostate specific antigen 2) Ordering urine studies in women ≥ 65 without symptoms 3) Overtreating adults aged ≥ 75 with insulin or oral hypoglycemic medications. Two investigators independently coded transcripts using qualitative analysis. Results: Nineteen interviews were conducted across the three topics resulting in four themes. First, physicians were aware and knowledgeable of guidelines. Second, perceived patient preference towards overuse influenced physician action even when physicians felt strongly that testing was not indicated. Third, physicians overestimated benefits of a test and underemphasized potential harms. Fourth, physicians were resistant to change when patients appeared to be doing well. Conclusions: Though physicians expressed awareness to avoid overuse, deference to patient preferences and the tendency to distort the chance of benefit over harm influenced decisions to order testing. Approaches for decreasing unnecessary testing must account for perceived patient preferences, make the potential harms of overtesting salient, and address clinical inertia among patients who appear to be doing well.

Original languageEnglish (US)
Article number95
JournalBMC Family Practice
Issue number1
StatePublished - Dec 2021


  • Choosing Wisely
  • Older adults
  • Overuse

ASJC Scopus subject areas

  • Family Practice


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