Physicians and other health professionals frequently overestimate and underestimate the harms and benefits of medical treatments, screenings and tests, according to a recently published systematic review of medical literature on the subject. Decision-support tools can help address knowledge gaps and inform patient-physician discussions.

Researchers did a comprehensive search of four medical databases and found 48 articles published between 1981 and 2015 examining 13,011 clinicians’ knowledge of harms and benefits. Nine of the articles surveyed physicians along with other health professionals, such as physician assistants or nurses. The vast majority of the 48 studies, however, focused solely on physicians’ knowledge in areas such as medication, imaging, cancer screening, fetal and maternal medicine, and cardiovascular disease prevention and management.

In the studies that examined how often clinicians correctly estimated interventions’ benefits, a majority of respondents provided the right answer for just three in 28 interventions. Of the studies that examined harm expectations, most of the clinicians provided the correct estimate for only nine out of 69 interventions.

When it came to underestimating the harm of tests, screenings or treatments, a majority did so for 20 out of 58 interventions. For example, more than 90 percent of respondents underestimated the fatal cancer risk from a bone scan. Most clinicians overestimated benefits for seven out of 22 interventions examined. As a case in point, greater than 60 percent of clinicians overestimated how much antibiotics could help relieve the pain of tonsillitis.

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