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Conversations on Medical Overuse

Estimates indicate that overuse of health care resources account for up to a third of health care spending in the United States. Talking with your patient about overuse can be difficult, especially when a patient or family member expects care that may be unnecessary or may carry risks.  Clinicians may be concerned about litigation or the prospect of negatively affecting the patient experience when they are not able to meet patients’ demands for particular services. However, a sizable percentage of patients choosing elective care would have avoided it, had they better understood their choices and the tradeoffs involved.Through collaborative conversations, patients can better understand the issues surrounding the effects of overuse, and clinicians can better understand the perspective of the patients they serve.

What’s included in each podcast?

A routine conversation, which demonstrates how a conversation might typically go in a routine, busy practice.

Skilled versions of patient-clinician conversations, which highlight more optimal approaches for addressing conversations on overuse. The types of skilled versions of conversations include:

  • Simple conversation—The patient initially demonstrates slight resistance to the clinician recommendation but maintains trust—and has no strong emotion about the change.
  • Complicated conversation—The patient has additional hesitation and/or disagreement with the recommendation.
  • Polarized conversation—Strong differences between the clinician and patient lead to persistent disagreement. Polarized conversations often result in the clinician’s yielding to the patient’s request or in declining the request with expressions of frustration or anger.

A debrief, in which the hosts reflect on the differences in tone, style, language, and patient validation.


Bill Doherty, Ph.D., a Professor and past Director of the Marriage and Family Therapy Program in the Department of Family Social Science, College of Education and Human Development, at the University of Minnesota, and an Adjunct Professor in the University of Minnesota’s Department of Family Medicine and Community Health.

Cate McKegney, MD, MS, a primary care physician practicing in Edina, Minnesota.


  1. Waste and Inefficiency in the US Health Care System—Clinical Care: A Comprehensive Analysis in Support of System-wide Improvements.
  2. Decision aids for people facing health treatment or screening decisions.

Earn MOC Part IV-CME Credit



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