Despite the evidence, physicians still order screening PSA’s to populations that may not need the test. Who tends to be the culprits?
Practitioners who were urology specialists, male, infrequent PSA test orderers, and affiliated with specific hospitals had significantly higher levels of inappropriate PSA screening. Compared with attending physicians, nurses and physician assistants had significantly lower levels of inappropriate screening. Under multivariate modeling, infrequent PSA test ordering and hospital affiliation retained statistical significance. The percentage of inappropriate PSA screening increased significantly with the age of male health care providers.
(via White Coat Notes)
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{ 7 comments }
So the better trained and more experienced are less likely to follow guideline, are more likely to exercise their own judgment, than those whose training is to just follow guidelines. Where is the news here? Maybe the urologists and older docs how unreliable and fragile guidelines, consensus panels, and expert recommendations really are.
Maybe the urologists and older docs how unreliable and fragile guidelines, consensus panels, and expert recommendations really are.
Or maybe they are too arrogant to ignore guidelines based on studies and evidence and rely on their entirely anecdotal information.
Or maybe urologists order PSA more often because they are being sent problems that have prostate cancer in the differential and it needs to be ruled out. Look beyond the stats here guys. Just because a urologist finds more bladder cancer does that mean if you go to a urologist you are more likely to have bladder cancer. Think!
Or maybe Urologist order more PSA’s because they know that there are a lot of false positives but the only way to rule that out is to perform a very lucrative procedure (biopsy of the Prostrate) that coincidently they are able to perform. No that couldn’t be. No responsible Physician would want to order tests that could lead to unnecessary procedures.
Yeah… maybe… but more likely you don’t know what you are talking about becuase you have never studied stats.
ERMURSE: Prostate biopsies are a loss leader in my office(I am a urologist). Medicare does not pay enought to cover the cost to do the procedure unless the biopsy is positive.
Medicare does not pay enought to cover the cost to do the procedure unless the biopsy is positive
Yes, but there is this little thing called “overdiagnosis” that increases the number of positive biopsies as well.
More tests = more diagnoses; but as of yet this hasn’t been shown to actually reduce mortality.
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