How are junior doctors managing patients with self-limiting illnesses at their first presentation? A video vignette study.

Abstract

To conduct a video vignette survey of medical students and doctors investigating test ordering for patients presenting with self-limiting or minor illness. Participants were shown six video vignettes of common self-limiting illnesses and invited to devise investigation and management plans for the patients' current presentation. The number of tests ordered was compared with those recommended by an expert panel. A Theory of Planned Behaviour Questionnaire explored participants' beliefs and attitudes about ordering tests in the context of self-limiting illness. Participants (n=61) were recruited from across Australia. All participants ordered at least one test that was not recommended by the experts in most cases. Presentations that focused mainly on symptoms (eg, in cases with bowel habit disturbance and fatigue) resulted in more tests being ordered. A test not recommended by experts was ordered on 54.9% of occasions. With regard to attitudes to test ordering, junior doctors were strongly influenced by social norms. The number of questionable tests ordered in this survey of 366 consultations has a projected cost of $17 000. This study suggests that there is some evidence of questionable test ordering by these participants with significant implications for costs to the health system. Further research is needed to explore the extent and reasons for test ordering by junior doctors across a range of clinical settings.