Excessive-insufficient diagnostics
Laboratory tests are the most frequently prescribed procedure by doctors. In the USA alone, more than 5 billion different analyses are performed annually.
A new study conducted by Beth Israel Medical Center specialists working under the guidance of Dr. Ramy Arnaout has shown that on average 30% of laboratory tests are prescribed unnecessarily. Moreover, it turned out that about the same number of tests are not prescribed in cases where they are necessary.
As part of the work, the researchers carefully analyzed 42 medical articles they found concerning the use of laboratory tests, the oldest of which is dated 1997. In total, the articles contained information about 1.6 million results of 50 frequently prescribed laboratory tests, including the most common ones, such as general and biochemical blood tests, and specific ones, such as the detection of D-dimers in the blood (used in the diagnosis of lung embolism) and antibodies to HIV-1.
Tests prescribed by a doctor, but not recommended in each specific case, were considered inappropriate, and those recommended by a doctor, but not prescribed by a doctor, were insufficiently used. The researchers also distinguished between incorrect laboratory examination at the first visit to the therapist and incorrect laboratory examination at repeated visits. An example of the latter is the repeated conduct of the same analysis during the period of hospitalization of the patient.
According to Arnaud, usually in discussions of laboratory overdiagnosis, doctors claim that there is an excessive appointment of repeated laboratory tests. However, the study showed that the main problem, on the contrary, is the appointment of unnecessary tests during the first visit.
The authors also analyzed the criteria that guide doctors when prescribing laboratory tests. It turned out that laboratory diagnostics is an exception to the "restrictive" rule adopted in medicine. For clarity, Dr. Arnault explains that if this rule did not exist, a doctor could amputate a patient's limb only on the basis that there are no reasons on his list why he should not do it. When prescribing laboratory tests, doctors, on the contrary, often resort to the "permissive" criterion and ask themselves the question "Why not?" instead of "Why?"
It is obvious that laboratory diagnostics plays an extremely important role in medicine, therefore, measures aimed at improving the effectiveness of prescribing tests should improve the quality of medical care.
Article by Ming Zhi et al. The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis published in the journal PLoS ONE.
Evgeniya Ryabtseva
Portal "Eternal youth" http://vechnayamolodost.ru based on the materials of Beth Israel Deaconess Medical Center:
Large-Scale Analysis Describes Inappropriate Lab Testing Throughout Medicine.
19.11.2013