Are We Docs Really Slaves to Tests?
It is true that my last two entries were about laboratory tests, but I want to call to your attention an excellent op-ed piece that was in today’s NYT. The article was entitled: “The doctor as a slave to tests,” and written by a physician, Abigail Zucker (the article was actually published on-line the day before with the title: “Quantifying tests, instead of good care”). Dr. Zucker argues that we physicians order far too many laboratory tests, in part because of our training- we are taught to problem solve by ordering tests. There is little debate in the medical community that we health professionals (yes, I mean you nurse practitioners and physician assistants, too) order too many laboratory tests. I know it used to be said that we ordered so many tests because we were worried about being sued. That may have a tiny bit to do with our test ordering proclivity, but studies have shown that fear of law suits is not a driving force for the voluminous number of laboratory tests that we order. Anyway, I think the article is worth reading, particularly since there is a movement afoot to save money by cutting back on laboratory testing (e.g., cholesterol testing, prostate cancer testing), as if that was a key reason why U.S. health care costs so much (it isn’t). The big question here is how do we train those of us who order tests on patients to think before ordering the “standard battery” of tests for this or that health care problem. I try to teach medial students and young physicians that before ordering any laboratory test or procedure we need to ask ourselves whether the test result is likely to help make a diagnosis or to guide therapy. In addition, we need to ask ourselves whether the test can wait until other test results are assessed- maybe we won’t need to do the test at all.