Opdal Per Øystein, Meland Eivind, Hjörleifsson Stefan
a Department of Global Health and Primary Care , University of Bergen , Bergen , Norway.
b Research Unit for General Practice , NORCE Norwegian Research Center , Norway.
Scand J Prim Health Care. 2019 Mar;37(1):135-140. doi: 10.1080/02813432.2019.1569370. Epub 2019 Jan 31.
To obtain first-hand in-depth accounts of overtesting amongst GPs in Norway, as well as the GPs' perspectives on drivers of overtesting and strategies that can prevent overtesting.
Four focus groups with GPs were conducted. All participants were asked to share examples of unnecessary testing from their everyday general practice, to identify the driving forces involved in these examples and discuss any measures that might prevent excessive testing. All authors collaborated on the analysis, conducted as systematic text condensation, using critical incident technique.
This study reveals two main positions regarding overtesting in general practice. In the categorical position there is no such thing as overtesting and GPs are obliged to perform extensive investigations on the suspicion that any person can carry a fatal disease, no matter how minor or absent their symptoms are. In contrast, in the dilemmatic position, the GPs acknowledge that investigations can cause significant harm, but still feel pressured to discover disease at the earliest opportunity and to meet patients' demands. The GPs' strategies for resolving this dilemma are often demanding and not always successful, but sharing uncertainty and fallibility with patients and colleagues appears to be the most promising strategy.
Our study indicates that GPs in Norway experience a strong pressure to discover any instance of disease and to meet patients' demands for investigations. One way of preventing the harm that accrues from overtesting is openly sharing uncertainty and fallibility with patients and colleagues.
获取挪威全科医生过度检查的第一手深入描述，以及全科医生对过度检查驱动因素和可预防过度检查策略的看法。
对全科医生进行了四个焦点小组访谈。要求所有参与者分享日常全科医疗中不必要检查的例子，确定这些例子中的驱动因素，并讨论可能防止过度检查的任何措施。所有作者共同进行分析，采用关键事件技术进行系统的文本浓缩。
本研究揭示了全科医疗中关于过度检查的两种主要立场。在绝对立场中，不存在过度检查这种情况，全科医生有义务对任何可能患有致命疾病的人进行广泛检查，无论其症状多么轻微或不存在。相比之下，在两难立场中，全科医生承认检查可能会造成重大伤害，但仍感到有压力尽早发现疾病并满足患者需求。全科医生解决这一两难困境的策略往往要求很高且并不总是成功，但与患者和同事分享不确定性和易犯错性似乎是最有前景的策略。
我们的研究表明，挪威的全科医生在发现任何疾病病例和满足患者检查需求方面面临巨大压力。防止过度检查造成伤害的一种方法是与患者和同事公开分享不确定性和易犯错性。
