Discussion
AIDS, PCP
In this initial randomized trial of a physician-facing and patient-facing peer comparison and educational intervention, we did not observe statistically or clinically significantOur educational intervention was designed to improve patient-clinician conversations by bolstering general medical test literacy, in contrast to prior studies evaluating decision aids for specific decisions such as knee surgeryAlthough competing demands are a real issue in packed primary care visits,Our results highlight challenges in intervening on trusting patient-physician relationships with established testing norms. Our study included PCPs with higher testing rates; patients choosing to stay with these physicians likely had concordant preferences. Interestingly, among patients who had known their PCP for less than 3 years, intervention and control group patients still had similar outcomes. We found patients trusted their physicians to offer only necessary tests. At the same time, physicians assumed their patients wanted more tests, though evidence suggests otherwise: patients wish their physicians talked to them about potential incidental findings before they occurredOur results also reflect the engrained more-is-more culture in health care (which may be stronger among patients choosing to attend annual examinations),Our results suggest that test conversations remain an important target for intervention. In future iterations, the physician intervention may require additional components such as clinic-wide implementation, support from clinic directors or local clinical champions,