Interviewee

Dr Marloes A van Bokhoven, Care and Public Health Research Institute (CAPHRI), University of Maastricht, The Netherlands

Article

Bokhoven, M., Pleunis-van Empel, MC., Koch, H., Grol, RP., Dinant, GJ., & van der Weijden, T.(2006) Why do patients want to have their blood tested? A qualitative study of patient expectations in general practice. BMC Family Practice, 7: 75-83.

Summary

Hamish Holewa interviews Dr Marloes van Bokhoven about work she has done exploring why patients want to have their blood tested. Marloes discusses her motivation for conducting research into patients' expectations of blood testing; her findings that patients' often hold high expectations of blood testing; and the fundamental tension highlighted in her research between maintaining the magic of testing and handling the misunderstood disadvantages associated with screening.

Transcript

Hamish Holewa: Welcome to IPP-SHR Podcasts, I’m Hamish Holewa and today we are speaking with Loes van Bokhoven from the University of Maastricht in the Netherlands. Loes works part-time as a GP near Oslo and is also a researcher at the Department of General Practice, University Maastricht. We are talking today with Loes about her recent article published in the BMC Family Practice titled, ‘Why do patients want to have their blood tested? A qualitative study of patients’ expectations in General Practice’, which she co-authored with others listed on our website. We start off today’s podcast by asking Loes what led her to research on the topic of patients’ expectations with regards to blood testing.

Loes van Bokhoven: Well we were busy developing a quality improvement strategy regarding GP’s blood test ordering and what we learnt from GP’s was that an important determinant for them was the patient’s request at least they felt that the patient frequently requested blood tests and then we thought why is that actually and that was the basis for our study.

Hamish Holewa: Sure, and looking at your article you mention that GP’s often order blood tests without appropriate pre-defined medical reasons. Do you want to summarize this for our audience?

Loes van Bokhoven: Well there have been several research projects about that topic, some that compare test ordering to guidelines and show that compared to the advice in the guidelines, testing is superfluous and other findings is that there is a lot inter-doctor variances and also inter-regional variances. A colleague of mine found that there was even a three-fold inter-regional variance which could not be explained by case mix and these differences are also between countries. A final type of research I think is that, well when you interview GP’s about the determinants of test ordering they mention several more medical reasons like the patient’s request or efficiency reasons or strategic reasons. For example, they order tests as an alternative to referral or more expensive tests. I think that all findings that point at a superfluous test ordering from a diagnostic point of view.

Hamish Holewa: In your article you went on to discuss the high patient expectations with regards to the magic and benefits of blood testing. Would you like to talk about this idea and what you found in your study?

Loes van Bokhoven: At least the GP’s feel that the patients demand that and we know also that the patients have really high expectations from tests. In a Dutch questionnaire survey the patients said I prefer a thousand patients tested for no, well superfluously than one patient with a misdiagnoses so patients really want to be tested I think and what we found was if they expect to be tested they expect certainty about their health, especially good health and they over estimate the test quality.

Loes van Bokhoven: Well I think that’s difficult because as a GP I find it comfortable to be able to use testing sometimes and not only because it’s efficient as explaining the limited value of tests is frequently time consuming but also because I can really reassure patients with testing sometimes and these patients sometimes I have difficulty with reassuring in another way. However, I think more and more tests become available also self tests which can be done independently of a doctor and I think if patients do not know the limitations that any tests have they run the risk of being vulnerable actually to advertisements. For example of tests manufacturers and that might result in high costs for the patients but also in anxiety due to false positive test results which may inevitably occur if many patients are tested for not very well reasons. Some information needs to be given to patients about the limitations of tests.