Patient-Centered Communication and Diagnostic Testing

Epstein et al discuss in their paper, which recently appeared in the September/October issue of Annals of Family Medicine, the potential association between patient-centered communication and diagnostic testing. They report that patient-centered communication is associated with fewer diagnostic testing expenditures and increased visit length. They have extensively discussed the study limitations as well as the benefits and limitations of the standardized patients used in their study.

Beyond the methodological considerations and their potential effects on the study's external validity, this report opens a challenging debate for both family physicians and policy makers, who are struggling to reduce high healthcare costs while equitably allocating resources. It is obvious that further studies should answer the question “is this approach, based on patient-centered communication, cheaper?” introducing a “cost-minimization” or “cost-effectiveness” analysis. The authors of this study have stated that “it was unclear whether the reduction in testing affected the quality of care”. Pharmacy expenditures have also not been measured, although empirical data from my country (Greece) support that those primary care physicians who practice with a biomedical style prescribe more than the others. It is an interesting question to what extent family physicians who scored high in doctor-patient communication were choosing tests that generated a high likelihood ratio. It is too early to judge whether such physicians’ performance altered the post-test probability of certain tests in selected conditions, indicating a need for sensitivity analysis. As the authors stated “all these should be confirmed in future randomized trials”.

Competing interests:   None declared