Think before ordering that test

Capsule:
Conceptions

Author:
Mark Sigman, M.D.

Volume 100, Issue 1, Pages 43-44, July 2013

Abstract:

What are the criteria for determining if a test is necessary?

  • Jason Kovac

    I agree. Being from Canada we are trained to always think of the cost of a test and the necessities of doing it. Perhaps some of that discussion will circle back to the practice of ordering tests like DNA fragmentation that, while informative, may not change what the physician is going to do.

  • Excellent commentary. I agree with Alex. When we are rushing through a clinic, and oftentimes with residents/med students, it is easier to order the test(s) rather than explain why we don’t need to order an examination.

    I think clinician education is also in order. The obstructive vs. non-obstructive azoospermia evaluation by referring clinicians is probably one of the most financially wasteful workups one has to pay for. Oftentimes, a significant portion of the testing could have been avoided on a thorough history and physical. Patients are being saddled with the costs.

    This commentary becomes more important as insurance companies continue to decrease reimbursements and require clinical indications in order to authorize testing.

  • This commentary should be mandatory reading for medical students, residents and fellows. Having trained in England and worked for the NHS there, the question “How is it going to change your management” is forever engrained in my thinking when ordering tests. Brainless ordering of tests is one of the biggest flaws of a health system with the attitude “more is better”. I am actually surprised that just 5% of health care costs are wasted on bad test-ordering, I would have thought that number was higher.

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