A study in Archives of Internal Medicine surveyed a national sample of internists and family physicians about cost issues in medicine. Over 600 responded.
42% felt that most patients in their own practices receive too much care, only 6% said too little. When asked why some patients received too much care, malpractice concerns, clinical performance measures (i.e. these physician report cards), and lack of time were the most given reasons. They also thought financial incentives caused ologists to over test patients.
It strikes me that for two out of the three causes of too much care, the patient-centered medical home (PCMH) cheerleaders are making things worse, at least many of them (I know of a few exceptions). They insist on robotic quality measures with no way to report exceptions. Many, but not all, of the PCMH pushers also are driving family physicians away from their patients into managerial roles, not creating new payment mechanisms to pay family physicians for the time to do meaningful work.
Until the suits realize it takes two minutes to fill out a consult form, but much more time to perform a procedure in addition to an office visit or deal with a litany of inter-related patient concerns, the full potential of family medicine will not be achieved.