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Testy Personalities

6/24/2015-

by Stephany Below, SIOP Communications Manager

Physician Personality Associated With Excessive Medical Diagnostic Test-Ordering

As healthcare costs in the United States continue to rise, reducing waste in the healthcare system has the potential to help alleviate this great financial burden.

One way to reduce waste and keep costs down is to minimize the use of excessive medical testing. In a recent meta-analysis, SIOP members show that identifying the doctors who are more likely to order these excessive diagnostic tests may be as simple as giving them a test of their own—a personality test.

In their analysis, researchers Martin Yu, University of Minnesota, and Fellow Nathan Kuncel, University of Minnesota, aggregated the data from ten studies that found associations between physician personality traits and excessive ordering of medical diagnostic tests. They examined the association between excessive medical diagnostic test-ordering and the physician personality traits of risk-taking, tolerance for uncertainty, introversion/extroversion, and intuition/sensing. Excessive test-ordering was moderately correlated with risk-taking, introversion, and intuition, and weakly correlated with tolerance for uncertainty.

Kuncel said this finding has implications for reducing waste in healthcare spending by intervening with physicians who are more likely to exhibit wasteful test-ordering behavior, as well as for job performance research, where focusing on associating personality with specific job behaviors will allow for subsequent predictive relationships to be determined.

“At a minimum, this analysis might provide information to help target interventions to reduce unnecessary testing,” Kuncel said. “Unnecessary testing not only wastes money and provides redundant information, but it can have other negative effects, such as the effects of testing on the patient.” 

Kuncel said he and Yu decided to perform the meta-analysis because they were looking for something interesting to do over the summer, but they also had a more serious reason. 

“Linking specific behaviors with personality traits helps establish more powerful evidence for why personality matters,” he explained.

Personality is known to be a valid predictor of job performance and other life outcomes. In the past, various interventions have been attempted, such as education and providing feedback. However, the efficacy of these interventions has been fairly limited and varying, partly due to the fact that there are individual differences between physicians who order tests, the authors explained. Thus, one approach to increasing the efficacy of interventions would be to identify some commonality among physicians with excessive test-ordering behavior

For this analysis, studies that measured physician personality traits and associated them with excessive medical diagnostic test-ordering behavior were compiled from literature searches done in Google Scholar. First, a broad search was carried out to examine any study that bore some relevance to the topic at hand. Abstracts were examined to identify any new relevant key words, which were then incorporated into the literature search. The researchers collected an initial set of potential articles for inclusion in the meta-analysis, and additional articles were identified from the references provided by these articles. They also examined all of the studies that cited papers they had obtained that were on the topic of predicting physician test ordering with individual differences. These articles were then read over and any article that did not evaluate physician personality traits and/or test-ordering behavior was rejected from final inclusion in the meta-analysis. In total, the data from 10 journal articles are presented in this meta-analysis.

For those studies that did not report correlations, correlations between physician personality traits and test-ordering were computed from the available data. They also coded any reported inter-correlations among the personality traits for potential estimation of incremental validity.

Several personality traits were identified from the included studies, including risk-taking, tolerance for uncertainty, introversion/extroversion, and intuition/sensing. People high on the “tolerance for uncertainty” trait will tend to be more impulsive, Yu explained, such that they don't often make concrete plans or follow set rules.

“They worry less and are more likely to be less stressed than those low on this trait,” he added.

Some of the typical statements used to determine tolerance for uncertainty are “Uncertainty makes me uneasy, anxious, or stressed,” “My mind can't be relaxed if I don't know what's happening tomorrow,” and “It frustrates me not having all the information I need.”

Those high in intuition reflect on the meaning of information and the patterns in it, Yu added.

“They believe they learn better by thinking over problems rather than having hands-on work,” he said.

Example statements used to determine this personality trait would be “I remember events by what I read ‘between the lines’ about their meaning,” “I solve problems by leaping between different ideas and possibilities,” and “I trust impressions, symbols, and metaphors more than what I actually experienced.”

Almost every study included in the analyses measured test-ordering as the number or mean number of medical diagnostic tests ordered over some time period. The results of the meta-analysis indicate that there are moderate associations between medical diagnostic test ordering and physician personality traits of risk-taking, introversion, and intuition, and a weak association between test ordering and tolerance for uncertainty.

“These correlations are not large in an absolute sense,” Kuncel said. “However, they are important when considering the number of tests a doctor might order across a career multiplied by the number of physicians in the workforce.  Subtle effects accumulate into huge outcomes.”

Because of these associations, the researchers note, it would potentially be feasible to utilize personality measures as a method of identifying those physicians who have a higher likelihood of exhibiting counterproductive and wasteful excessive test-ordering behavior. Interventions can then be carried out on these physicians to ultimately reduce this excessive test-ordering behavior.

“Health care costs are a major concern, and understanding why and where money is wasted is important,” Kuncel said. “Ultimately, it is the result of human decision making.”