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Patient Safety in Surgery
Published in: Patient Safety in Surgery 1/2017

Open Access 01-12-2017 | Research

Exploring unnecessary invasive procedures in the United States: a retrospective mixed-methods analysis of cases from 2008-2016

Authors: James M. DuBois, John T. Chibnall, Emily E. Anderson, Heidi A. Walsh, Michelle Eggers, Kari Baldwin, Kelly K. Dineen

Published in: Patient Safety in Surgery | Issue 1/2017

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Abstract

Background

Unnecessary invasive procedures risk harming patients physically, emotionally, and financially. Very little is known about the factors that provide the motive, means, and opportunity (MMO) for unnecessary procedures.

Methods

This project used a mixed-methods design that involved five key steps: (1) systematically searching the literature to identify cases of unnecessary procedures reported from 2008 to 2016; (2) identifying all medical board, court, and news records on relevant cases; (3) coding all relevant records using a structured codebook of case characteristics; (4) analyzing each case using a MMO framework to develop a causal theory of the case; and (5) identifying typologies of cases through a two-step cluster analysis using variables hypothesized to be causally related to unnecessary procedures.

Results

Seventy-nine cases met inclusion criteria. The mean number of documents or sources examined for each case was 36.4. Unnecessary procedures were performed for at least five years in most cases (53.2%); 56.3% of the cases involved 30 or more patients, and 37.5% involved 100 or more patients. In nearly all cases the physician was male (96.2%) and working in private practice (92.4%); 57.0% of the physicians had an accomplice, 48.1% were 50 years of age or older, and 40.5% trained outside the U.S. The most common motives were financial gain (92.4%) and suspected antisocial personality (48.1%), followed by poor problem-solving or clinical skills (11.4%) and ambition (3.8%). The most common environmental factors that provided opportunity for unnecessary procedures included a lack of oversight (40.5%) or oversight failures (39.2%), a corrupt moral climate (26.6%), vulnerable patients (20.3%), and financial conflicts of interest (13.9%).

Conclusions

Unnecessary procedures usually appear motivated by financial gain and occur in settings that have oversight problems. Preventive efforts should focus on early detection by peers and institutions, and decisive action by medical boards and federal prosecutors.
Footnotes
1
The following terms were used in the search strategy: ((Physician OR Doc OR Doctor OR Dr. OR Surgeon OR Psychiatrist OR Pediatrician OR!Surgeon OR Oncologist) W/20 (Charg! OR Accus! OR Convict! OR Revok! OR Suspen! OR Disciplin! OR Fine! OR Sanction! OR Probation OR Censure! OR Arrest! OR Guilty OR Settle! OR Agreement OR Sue! OR!Suit!)) AND ((Unneeded OR Unnecessary OR Unwarranted OR Fraud!) w/2 (Surger! OR Operat! OR Test! OR Lab! OR Treatment OR Inject! OR Procedure OR Imag! OR Diagnos! OR Stent! OR Chemo! OR!Fusion!))
 
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Metadata
Title
Exploring unnecessary invasive procedures in the United States: a retrospective mixed-methods analysis of cases from 2008-2016
Authors
James M. DuBois
John T. Chibnall
Emily E. Anderson
Heidi A. Walsh
Michelle Eggers
Kari Baldwin
Kelly K. Dineen
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Patient Safety in Surgery / Issue 1/2017
Electronic ISSN: 1754-9493
DOI
https://doi.org/10.1186/s13037-017-0144-y

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