Appealing to patients’ altruism to reduce low value care: surprise surprise, it doesn’t work

Not only that, it results in lower physician ratings.  From a recent paper in JGIM:

Objective

To determine whether altruistic appeals reduce hypothetical requests for overused services and affect physician ratings.

Design

Experimental survey using hypothetical vignettes describing three overused health services (antibiotics for acute sinusitis, imaging for acute low back pain, and annual exams for healthy adults).

Participants

U.S. adults recruited from Research Now, an online panel of individuals compensated for performing academic and marketing research surveys.

Interventions

In the control version of the vignettes, the physician’s rationale for recommending against the service was the minimal benefit and potential for harm. In the altruism version, the rationale additionally included potential benefit to others by forgoing that service.

Main Measures

Differences in requests for overused services and physician ratings between participants randomized to the control and altruism versions of the vignettes.

Key Results

A total of 1001 participants were included in the final analyses. There were no significant differences in requests for overused services for any of the clinical scenarios (P values ranged from 0.183 to 0.547). Physician ratings were lower in the altruism version for the acute sinusitis (6.68 vs. 7.03, P = 0.012) and back pain scenarios (6.14 vs. 6.83, P less than 0.001), and marginally lower for the healthy adult scenario (5.27 vs. 5.57, P = 0.084).

Conclusions

In this experimental survey, altruistic appeals delivered by physicians did not reduce requests for overused services, and resulted in more negative physician ratings. Further studies are warranted to determine whether alternative methods of appealing to patient altruism can reduce overuse.

Though this study is not very “real world” it makes sense, especially the finding of lower physician ratings.

An argument against low value care based on ineffectiveness is fine and patients ought to be able to respect it.  But an appeal to altruism sends a message that you can’t whole heartedly advocate for them as individuals. Imagine you are accused of a crime and your attorney says “I’ll work hard to represent you but please keep in mind the interests of ‘the people’ in these proceedings.”