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James S. Hernandez, MD, MS, discusses the importance of appropriate laboratory testing.
I’d like to take a few minutes to talk to you about laboratory test utilization.
There are some common misconceptions about this subject. The first is that most doctors are comfortable ordering most tests. Not necessarily true—as the number of tests continually increases, no one can be proficient in all areas. The second is that experienced physicians need less help in ordering and interpreting tests compared to younger colleagues. Also not always true. All physicians have gaps in their knowledge and the gaps are growing because of the number and complexity of available tests. And last is the thought that physicians will get upset if offered help. The opposite is true. If approached as a respected colleague, most physicians welcome your help
In my experience, physicians welcome help from pathologists, laboratory scientists and laboratorians in choosing the best strategy to make a diagnosis or assess therapy using laboratory tests. In addition to suggesting useful tests, the laboratory’s role in creating an environment for this to happen includes eliminating obsolete tests as well as destroying out dated paper requisitions. Also, in primary care settings, consider restricting electronic order access of esoteric tests or eliminating them from requisitions.
Here are some hints on eliminating out-of-date tests:
We recommend literature-supported evidence to guide development of local guidelines, especially cost-effective algorithms, when the differential diagnosis is complex. Mayo Medical Laboratories has developed a set of algorithms for this purpose that may be accessed at www.mayomedicallaboratories.com.
While most test orders are suitable, some are overordered or ordered inappropriately. Through a series of Hot Topics, available at www.mayomedicallaboratories.com, we offer information and data to assist laboratories in their expanding role in appropriate test selection.
Working together with the medical staff, laboratories can help the physician to choose the right test at the right time for the right patient.