Doctors' approaches to XXXX testing and overdiagnosis in primary healthcare: a qualitative study.

@entity1 @entity263 @entity1486
OBJECTIVES: (1) To explain general practitioners' (GPs') approaches to @entity1486 ( @entity1486 ) testing and overdiagnosis; (2) to explain how GPs reason about their @entity1486 testing routines and (3) to explain how these routines influence GPs' personal experience as clinicians. SETTING: Primary care practices in Australia including @entity1 's health clinics and rural practices with variable access to urology services. @entity1 : 32 urban and rural GPs within Australia. We included GPs of varying ages, gender (11 female), clinical experience and @entity1 populations. All GPs interested in participating in the study were included. PRIMARY AND SECONDARY OUTCOME MEASURES: Data were analysed using grounded theory methods to determine how and why GPs provide (or do not provide) @entity1486 testing to their asymptomatic male @entity1 . RESULTS: We observed patterned variation in GP practice, and identified four heuristics to describe GP preference for, and approaches to, @entity1486 testing and overdiagnosis: (1) GPs who prioritised avoiding underdiagnosis, (2) GPs who weighed underdiagnosis and overdiagnosis case by case, (3) GPs who prioritised avoiding overdiagnosis and (4) GPs who did not engage with overdiagnosis at all. The heuristics guided GPs' Routine Practice (usual testing, communication and responses to @entity1 request). The heuristics also reflected GPs' different Practice Rationales (drawing on experience, medicolegal obligations, guidelines and evidence) and produced different Practice Outcomes (GPs' experiences of the consequences of their @entity1486 testing decisions). Some of these heuristics were more responsive to @entity1 preferences than others. CONCLUSIONS: Variation in GPs' @entity1486 testing practices is strongly related to their approach to overdiagnosis and underdiagnosis of @entity263 . @entity1 receive very different care depending on their GP's reasoning and practice preferences. Future policy to address overdiagnosis will be more likely to succeed if it responds to these patterned variations.
