Why Doctors Abuse Lab Tests
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.
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?