Medical Journal of the Islamic Republic Of Iran

en Physicians' Attitudes Toward Unnecessary Medical Services: Ethical and Systemic Challenges in Fourth Level Prevention - Tehran 2024 Health Health Original Research Original Research Background: The provision of unnecessary services within healthcare systems is prevalent, costly, prone to complications, and detrimental to patient care. The aim of the present study is to examine physicians' attitudes toward unnecessary tests and procedures at a referring hospital.    Methods: This study was conducted as a cross-sectional study. The sampling population comprised all physicians employed at a referral University Hospital in 2024. The study utilized a validated questionnaire to collect data over a 6-month period. Analyses were reported descriptively for qualitative variables as frequency and percentage, and for quantitative variables as mean and standard deviation. Chi-square tests and Fisher's exact test were employed for comparisons. Analyses were conducted using SPSS-22.0.    Results: A total of 196 physicians participated in the study, with a mean age of 34.69 (± 9.29) years and an average of 9.45 (± 6.36) years of clinical experience. Approximately 89.8% of the participants regarded the repetition of unnecessary tests and procedures as a significant issue within the healthcare system. About 92.3% reported that patients sometimes or rarely comply with physicians' recommendations to avoid unnecessary procedures. Furthermore, 55.1% identified patient insistence as the primary reason for prescribing unnecessary services. A substantial 83.2% of physicians believed that spending more time with patients and educating them about alternative tests or procedures would effectively reduce unnecessary services. Additionally, 81.6% of physicians considered reforms in medical malpractice follow-up to be effective in decreasing unnecessary service prescriptions, while 88.2% deemed changes to the financing system as effective in this regard. However, 90.8% reported actively working to reduce unnecessary tests. The attitude scores of specialist physicians regarding unnecessary services were significantly higher than those of residents (P-value=0.027).    Conclusion: The provision of unnecessary services poses a significant challenge within the healthcare system. The primary causes of this issue include patient insistence and physicians' fear of legal complaints. Addressing this problem necessitates systemic reforms focused on the role of physicians.   Physicians, Attitude, Unnecessary, Health Care, Health System, Medical 275 281 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-3069-4&slc_lang=en&sid=1 Mohsen Saberi Isfeedvajani drsaberihaji@gmail.com 200319475328460097273 200319475328460097273 No Spiritual Health Research Center, Life Style Institute & Department of Community Medicine, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran Esmat Davoudi-Monfared davoudimonfared@gmail.com 200319475328460097274 200319475328460097274 Yes Health Management Research Center, Life Style Institute, Department of Community Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran Jannat Mashayekhi mashayekhijannat@gmail.com 200319475328460097275 200319475328460097275 No Spiritual Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Sajjad Bahra sajjadbahra@gmail.com 200319475328460097276 0009-0001-2184-2544 No Baqiyatallah University of Medical Sciences, Tehran, Iran Mahboubeh Rouhollahei mrudim13@gmail.com 200319475328460097277 200319475328460097277 No Department of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran