# ‘Harm? I don’t think so!’: medical overuse from the perspective of allied health professionals in Germany – a qualitative study

## TL;DR

This study explores how allied health professionals in Germany perceive medical overuse, finding they are largely unaware of the issue and see it as less pressing than underuse.

## Contribution

The study provides new insights into medical overuse from the perspective of allied health professionals, a group previously under-researched in this context.

## Key findings

- Allied health professionals struggled to define medical overuse and prioritized underuse as a more urgent problem.
- Participants identified structural, economic, physician-driven, and patient-driven factors as potential drivers of overuse.
- AHPs believed their treatments, even when unnecessary, had minimal negative impact on patients.

## Abstract

Medical overuse is a well-documented increasing issue, primarily examined in the context of physicians. Previous research has also identified unnecessary services involving allied health professionals (AHPs). The objectives of our study were to explore: (1) To what extent are physiotherapists (PT), occupational therapists (OT) or speech and language therapists (SLT) familiar with the phenomenon of medical overuse?, (2) What drivers do PTs, OTs and SLTs suspect?, (3) What are the consequences of medical overuse? and (4) What measures can be taken to reduce medical overuse?

This study used a qualitative descriptive design and applied qualitative content analysis to explore the AHPs’ point of view. A qualitative content analysis using a deductive–inductive approach was conducted. After coding half of the interviews, no further categories were added, indicating data saturation.

Bavaria, Germany.

14 AHPs, mostly female.

AHPs struggled to define overuse. To them, underuse was perceived as a much more pressing issue. AHPs identified structural, economic, physician and patient-driven factors. They did not see themselves as part of the problem of medical overuse and assumed that their treatment, even without indication, has little to no disadvantage for patients. AHPs found it difficult to derive specific solutions; they named terminating unnecessary therapies and healthcare system reforms.

AHPs lacked initial awareness of medical overuse, highlighting the need for education and broader research.