One of the tenets outlined in the landmark Institute of Medicine report on health care quality was to prevent the "overuse" of care delivered when the potential harm exceeds the potential benefit from a given medication, diagnostic test, or procedure. This study surveyed more than 2300 Medicare beneficiaries and analyzed how frequently they wanted a test or referral in two clinical vignettes presented. Despite nearly 80% believing in the value of having a primary care doctor to manage their health, a significant number wanted a specialist referral or test even when their generalist did not deem it necessary. The findings highlight the challenges in providing patient-centered care when it doesn't always equate to patient satisfaction. A past AHRQ WebM&M commentary discussed the tension between these sometimes competing efforts.