PT  - JOURNAL ARTICLE
AU  - Cummins, Richard O.
TI  - Clinicians' Reasons for Overuse of Skull Radiographs
DP  - 1980 Jul 01
TA  - American Journal of Neuroradiology
PG  - 339--342
VI  - 1
IP  - 4
4099  - http://www.ajnr.org/content/1/4/339.short
4100  - http://www.ajnr.org/content/1/4/339.full
SO  - Am. J. Neuroradiol.1980 Jul 01; 1
AB  - 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.