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Abstract

Clinicians' Reasons for Overuse of Skull Radiographs

Richard O. Cummins
American Journal of Neuroradiology July 1980, 1 (4) 339-342;
Richard O. Cummins
1University of Washington, Seattle, WA 98195. Present address: London School of Hygiene and Tropical Medicine, Keppel St., London WC1E–7HT. Address reprint requests to Robert Wood Johnson Clinical Scholars Program, HQ–18, University of Washington, Seattle, WA 98195
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Abstract

Observations based on a high yield indication list (HYL) revealed that 80% of posttraumatic skull radiographs requested by physicians were not indicated. To investigate this possible overuse of radiography, 15 resident physicians who had used the HYL in a university emergency room were interviewed. The interviews included a questionnaire, case simulations, and discussion of actual head trauma patients. Several general reasons for the overuse were detected: (1) overriding indications to the HYL; (2) basic problem-solving strategies of the physicians (pattern recognition, method of exhaustion, and hypothesis generation and evaluation); (3) the context of the decision-making (patient and family expectations, mentor and peer pressure, malpractice threat, time management concerns); (4) fear of uncertainty; and (5) routines. It was found that overuse of diagnostic radiography was not perverse or irrational, but was produced by a complex mixture of actual expectation of yield from the procedure, personal approaches of the individual physicians, and pressures in the decision-making environment.

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American Journal of Neuroradiology
Vol. 1, Issue 4
1 Jul 1980
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Richard O. Cummins
Clinicians' Reasons for Overuse of Skull Radiographs
American Journal of Neuroradiology Jul 1980, 1 (4) 339-342;

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Clinicians' Reasons for Overuse of Skull Radiographs
Richard O. Cummins
American Journal of Neuroradiology Jul 1980, 1 (4) 339-342;
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