​Physicians' previous habits of ordering unnecessary imaging tests and their ownership in the imaging equipment are strong predictors that they may order "low-value imaging" for back pain and headache, says a study in the November 2017 issue of JAMA Internal Medicine. The researchers studied the use of radiography, computed tomography, and magnetic resonance imaging to evaluate patients with uncomplicated low back pain or headache. In the absence of other signs or symptoms that might indicate an underlying serious condition, imaging "adds little clinical value," the researchers said. They examined the insurance claims from a commercial health insurer of 100,977 clinicians to study predictors for low-value imaging orders. “Clinician characteristics such as ordering low-value imaging on a prior patient, high rates of low-value imaging in another clinical scenario, and ownership of imaging equipment are strong predictors of low-value back and headache imaging," the researchers wrote. Interventions such as providing regular feedback to clinicians about their performance metrics in comparison with their peers have shown promise in changing physician behavior, the researchers suggest. But other strategies may be needed to address varying levels of comfort among physicians with clinical uncertainty and fear of malpractice. The researchers urged physicians to be more financially responsible in ordering imaging studies because patients' insurance plans increasingly require cost sharing. Failure to do so will cause "financial toxicity" to patients, they write. 

HRC Recommends: Overuse of tests and procedures—a threat to the effective and efficient use of healthcare—has been attributed to a mix of factors, including defensive medicine and patient preference. It is sometimes hard to determine whether a test or a procedure is necessary. However, discussion between patients and physicians about the risks and benefits of tests and procedures and the patient's goals can lead to treatment that is both medically appropriate and in line with the patient's wishes. Providers should also perform a focused patient assessment and follow evidence based guidelines.