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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Why Doctors Abuse Lab Tests

Published September 16, 2012 2:37 PM by Glen McDaniel

One of the most frustrating   issues for clinical laboratorians is that clinicians continue to misuse laboratory testing. Laboratory utilization is a hot potato because of increased concerns with cost (to the laboratory and payer), extended length of stay  abnormal test gets worked up) and patient concerns (Am I sick? What does this mean?). As far as patients are concerned there are also the issues of phlebotomy-induced anemia, discomfort from multiple sticks and the risks (though minimal) from repeated phlebotomy.

Many laboratories have decided to undertake Laboratory Utilization initiatives from a financial, patient safety and performance improvement perspective. Appropriate utilization of tests benefits everyone. So why aren't physicians onboard?

Recently, at its annual meeting in Los Angeles,  AACC conducted a survey on key questions as to what factors impact laboratory utilization.  The AACC publication Clinical Laboratory News (CLN) posed the same questions as part of a survey conducted from July to August of this year.

The factors were ranked as Highly important, somewhat important, neutral or not important.  For the purposes of his blog, I will combine  the Highly Important and Somewhat Important scores for each. That is "Is this factor important in causing doctors to utilize lab tests incorrectly or over utilize tests. Four top factors got my attention.

  • Limited teaching about lab tests in medical school- 94%
  • Complexity of lab test names -77%
  • Inability to organize lab data from different sources-90%
  • Utilization of new tests before diagnostic/prognostic utility established-79%

So, to generalize,  it seems the basic reason is ignorance: not having the right information about what the various tests mean and how they should be utilized.

This brings up the need for clinical laboratorians to take more of  a lead in terms of education, interpretive reports,  developing reflex testing when appropriate, testing algorithms,  and limiting tests when not indicated.

Physicians need help so we need to offer that help rather than  simply say, "As the doctor, he/she should know better." They don't, so what are we doing about it?

7 comments

I think we make the mistake that doctors dont need our help and that since they are the ones making the big bucks then they need to make all the decisions. We have it all wrong. They are experts in their field and we are experts in OUR field.

The more we give them advice the more they expect it. The more they expect it then the more respected we will be. Who knows if we can prove we save lives and save money maybe we can bill for services. We cant just say it will never happen.

We have to prove ourselves first. Do a before and after study and then if we save the insurance company or save the hospital money then maybe we can start billing. But we cant just sit back and do what we have always done which is a big fat NOTHING.

Miriam Sidibeh, MT September 29, 2012 11:01 AM

Very interesting and informative article!  Lab staff should definitely go ahead and play their role if something doesn't seem right. In a hospital setting, lab and physicians can work like a team but this does not seem easy in out patient setting. For the sake of patients (both health and cost wise) there should be a way for better communication among health care providers.

Siddra D September 27, 2012 11:13 PM

excelent topic!!! you just brought up the very realistic problem that facing whole healh care community every day and every hospital and lab work. me and my co worker were talking almost about the same kind of problem we have every day and every shift such as doctors or nurses repeat test orders because they didn't know where it about if they don't see the result..is kind of tracking or follow up procedure confusion...but as all of you pointed out that the lab testing system and LIS technology is too broad and some how complicated to doctors and nurses or anybody else unless they are being helped and trained if not all at least the basics to be familiar with lab testing screen with that ordering pages. that would realy help evryone. I agree with all that help needed for doctors and nurses to understant where or and how to combine and follow up with thier ordering system.

thanks

salim a

Sep 26/12

salim ahmed, MICROBIOLOGY - MEDTECH, utmb September 26, 2012 1:45 AM
GALVESTON TX

Two words: CLIENT BILLING. There is huge financial incentive to order as much testing as possible.

lahkwinder singh, Yes Please September 25, 2012 1:54 PM

I agree totally with the educational need. The questions for me are how that is done and more self-interestedly, how that need can be exploited to bring more perceived value to the clinical laboratory profession. The traditional top-down medical delivery paradigm is no longer useful to laboratorians. 2% of cost accounts for 75% of medical decision-making. Everyone remember that. For the value we bring, we, relatively speaking, get very little. I understand that I might sound a bit radical but what you describe is a real need - docs can't keep up with our world. We need to parlay that into value (prestige, $$, esteem, etc.)

Steve September 25, 2012 11:17 AM

I just love this blog. You know that is something I have been saying for years. I have worked very well with physicians and nurses and several admitted to me that they are just confused about test selection and interpretation.

One physician seemed to double order A LOT . But I found out it was because the computer system was complicated and if he didnt see a result on the chart he'd just reorder the test. I showed him  how to check the status of an order-whether collected, partial resulted, pending, in transit to reference lab etc. He was ecstatic.

When I worked weekends I gained  quite a bit of rapport with the ED staff and they would call and ask for me. Not because I was so much smarter than my colleagues, but I took the time to explain. I cant tell you how many doctors said to me "I didnt know that" or "Finally it makes sense."

We need to educate more and complain less. It makes us feel proud, it helps the patient and makes our life in the lab easier too.

Carmelita Rosen September 18, 2012 7:25 PM

Excellent article. As a Laboratory Manager, I was constantly educating physicians, nurses, techs...well everyone. Laboratory medicine is always changing, evolving. Really, it's a full time job to keep up with it and educate your users, yet little is done to assure this. Thanks for pointing this out and hopefully all concerned will devote more time and effort to this endeavor. I know all those I educated were greatly appreciative, which made my job quite rewarding. And yes, don't cop to "the Dr. should know better" you might just be trying to make yourself feel smarter than the Dr., when (and don't be surprised) YOUR NOT!

Richard Oost September 18, 2012 2:11 PM

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