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.

Exploring emergency physicians’ knowledge, attitudes, and behaviour towards Choosing Wisely in Taiwan

“…The significant effect of age on the knowledge score of Choosing Wisely indicates that younger physicians are more knowledgeable about evidence-based medicine than older physicians. Similar results have been found in past studies, which can be explained by the more up-to-date academic training of younger physicians [ 21 ]. For example, Taiwan developed ‘post-graduate year training, PGY’ in 2003, adding evidence-based medicine to medical education; therefore, younger physicians have greater knowledge [ 33 ].…”

“…The mean correct rate of physicians in the knowledge construct of Choosing Wisely was 70.1%, which was consistent with the results in the United States and Spain [ 20 , 21 ], indicating that emergency physicians in Taiwan have sufficient knowledge of evidence-based medicine. However, Choosing Wisely is still not prevalently promoted in Taiwan, which indicates that there is a need to strengthen the understanding of the benefits of implementing Choosing Wisely.…”

Surgical Error Compensation Claims as a Patient Safety Indicator: Causes and Economic Consequences in the Murcia Health System, 2002 to 2018

“…32 Another cause of the inadequacy of IC could be its inappropriate form of administration because, in Spain, up to 58.1% of health professionals in the surgical field could have a misunderstanding of this practice, especially among those with more than 16 years of work experience. 33 The percentage of CC filed for retained surgical foreign bodies decided in favor of the individual (71.4%) agrees with that obtained in another study carried out in Spain in the field of GO (71.7%). 12 The causes of this type of incident have been studied in the United States, where it was associated with urgent operations, unexpected changes in surgical techniques, and high body mass index, 34 with surgical sponges being the most frequently forgotten surgical material, before clamps and needles.…”

“… 32 Another cause of the inadequacy of IC could be its inappropriate form of administration because, in Spain, up to 58.1% of health professionals in the surgical field could have a misunderstanding of this practice, especially among those with more than 16 years of work experience. 33 …”

How defensive medicine is defined in European medical literature: a systematic review

“…The studies were published during 1972–2021. Among those, the 50 European studies included in this systematic review2 3 5–8 16–20 22–25 34–68 were published during 1995–2020 with a steep increase in publications during the recent years (table 1, figure 2).…”