How Often do Medical Specialties Question the Practices that They Perform? An Empirical, Cross-Sectional Analysis of the Published Literature.

An aspect of overuse is who decides which practices are evaluated for overuse and which of the studies on overuse are published in the medical literature. We sought to examine the frequency with which studies in medical journals questioned an established practice. As a secondary objective, we sought to determine if there was variance among medical specialties. We conducted a retrospective, cross-sectional review of the published literature in 14 medical specialty journals. We included studies from one issue in three high-impact journals (November/December 2020) for each specialty. We assessed whether the study reported on a medical practice, whether it reported on an existing practice, whether the author expressed uncertainty regarding the practice, whether the study was a randomized design, and if the authors encouraged further testing in randomized studies. For all medical specialties combined, we found that 37% (n = 98) questioned existing practices, and 15% (n = 40) either tested the practice in a randomized trial or encouraged future randomized testing of the practice. The medical specialties that questioned their practices the most were gastroenterology (61%; n = 10/18), obstetrics/gynecology (52%; n = 11/21), and cardiovascular (50%; n = 5/10). These findings indicate that, although research is being conducted to examine current medical practices, few studies advocate for randomized testing of these practices, and even fewer actually test them in a randomized fashion. Additionally, the variation across medical specialties suggests areas in which to look for potential practices that are low-value, duplicative, and/or wasteful.