{"doi":"10.1016/j.mayocpiqo.2020.01.007","title":"Why Not? Persuading Clinicians to Reduce Overuse","abstract":"OBJECTIVE: To explore how best to deimplement nonrecommended medical services, which can result in excess costs and patient harm. METHODS: We conducted telephone interviews with 15 providers at 3 health systems from June 19 to November 21, 2017. Using the case of nonrecommended imaging in patients with cancer, participants assessed the potential for 7 rationales or \"arguments,\" each characterizing overuse in terms of a single problem type (cost or quality) and affected stakeholder group (clinicians, institutions, society, or patients), to convince colleagues to change their practices. We tested rationales for all problem-stakeholder combinations appearing in prior deimplementation studies. RESULTS: Participants' views varied widely. Relatively few found cost arguments powerful, except for patients' out-of-pocket costs. Participants were divided on institution-quality and clinician-quality rationales. Patient-quality rationales resonated strongly with nearly all participants. However, a \"yes, but\" phenomenon emerged: after initially expressing strong support for a rationale, participants often undercut it with denials or rationalizations. CONCLUSION: Deimplementation efforts should combine multiple rationales appealing to clinicians' diverse perspectives and priorities. In addition, efforts must consider the complex cognitive dynamics that can undercut data and reasoned argumentation.","journal":"Mayo Clinic Proceedings Innovations Quality & Outcomes","year":2020,"id":90036,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9684,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":455638,"name":"Katherine Diaz-Macinnis","orcid":null,"position":1,"is_corresponding":false},{"id":454514,"name":"Allison Lipitz‐Snyderman","orcid":"0000-0003-2423-2220","position":2,"is_corresponding":false},{"id":454515,"name":"Brooke Barrow","orcid":"0000-0002-2947-1506","position":3,"is_corresponding":false},{"id":438218,"name":"Deborah Korenstein","orcid":"0000-0003-1859-0574","position":4,"is_corresponding":false},{"id":438219,"name":"Susan Chimonas","orcid":"0000-0002-7742-5950","position":0,"is_corresponding":true}],"reference_count":51,"raw_metadata":null,"created_at":"2026-07-18T22:02:48.683291Z","pmid":"32542218","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}