Self-reported test ordering practices among Canadian internal medicine physicians and trainees: A multicenter cross-sectional survey

Thomas Bodley, Janice L. Kwan, John Matelski, Patrick J. Darragh, Peter Cram

Research output: Contribution to journalReview articlepeer-review


Background: Over-Testing is a recognized problem, but clinicians usually lack information about their personal test ordering volumes. In the absence of data, clinicians rely on self-perception to inform their test ordering practices. In this study we explore clinician self-perception of diagnostic test ordering intensity. Methods: We conducted a cross-sectional survey of inpatient General Internal Medicine (GIM) attending physicians and trainees at three Canadian teaching hospitals. We collected information about: self-reported test ordering intensity, perception of colleagues test ordering intensity, and importance of clinical utility, patient comfort, and cost when ordering tests. We compared responses of clinicians who self-identified as high vs low utilizers of diagnostic tests, and attending physicians vs trainees. Results: Only 15% of inpatient GIM clinicians self-identified as high utilizers of diagnostic tests, while 73% felt that GIM clinicians in aggregate ("others") order too many tests. Survey respondents identified clinical utility as important when choosing to order tests (selected by 94%), followed by patient comfort (48%) and cost (23%). Self-identified low/average utilizers of diagnostic tests were more likely to report considering cost compared to high utilizers (27% vs 5%, P = 0.04). Attending physicians were more likely to consider patient comfort (70% vs 41%, p = 0.01) and cost (42% vs 17%, p = 0.003) than trainees. Conclusions: In the absence of data, providers seem to recognize that over investigation is a problem, but few self-identify as being high test utilizers. Moreover, a significant percentage of respondents did not consider cost or patient discomfort when ordering tests. Our findings highlight challenges in reducing over-Testing in the current era.

Original languageEnglish (US)
Article number820
JournalBMC Health Services Research
Issue number1
StatePublished - Nov 8 2019
Externally publishedYes


  • Behavioural science
  • Diagnostic investigation
  • Hospital medicine
  • Quality improvement

ASJC Scopus subject areas

  • Health Policy


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