Additional Investigations and Referrals by Primary Care Physicians in Uncertain Clinical Situations: Cross-Sectional Study Using Virtual Patient–Based Scenarios

Background: Uncertainty affects at least 20% of primary care consultations, possibly leading primary care physicians to order additional investigations or referrals, affecting cost-effectiveness and patient safety. Experience is a key determinant in making these orders, along with anxiety or physicians' reactions to uncertainty. Past studies addressing the links between experience and additional investigations and referrals in uncertain situations have used questionnaires, database analyses, or interviews with general practitioners, but no study has used fully standardized conditions. Objective: This study aimed to examine the association between experience and orders for additional investigations and referrals in uncertain situations using a standardized virtual patient simulation. Methods: A cross-sectional study was conducted with 40 physicians stratified by sex and experience (