Unnecessary medical tests can add to a patient’s costs, discomfort and anxiety as more and more tests cascade in an effort to chase the cause of a symptom.
A doctor may order those tests out of a worthy desire to take care of a patient, according to University of Virginia researchers, but when the tests are not needed, they don’t add much value.
Instead, according to Dr. Andrew Parsons, a hospitalist and an assistant professor of medicine, and Joe Wiencek, a pathologist and an assistant professor of pathology, hospitals and medical schools can do a better job educating doctors and patients about what tests are supposed to do and when they’re effective — and when to avoid them. The two have teamed up as part of a UVa effort to examine levels of testing and try out various methods to ensure that only useful tests are ordered.
“Even in the beginning of medical school, they instill a culture that you should be quite thorough,” Parsons said. “And that makes sense, but we’re trying to switch that culture from thoroughness to appropriateness.”
In a June report for the journal Clinical Lab Manager, the two researchers wrote that low-value care costs the U.S. health care system an estimated $800 billion annually.
Bloodwork and imaging are two sets of tests that are often ordered routinely, sometimes daily, for a patient, according to Parsons. Monetary, physical and emotional costs for even simple tests can add up. And while a patient may push to order a test for a rare genetic marker or disease, those tests, too, can have high costs and emotional impact, and should be ordered carefully.
Hospital CEOs, doctors, medical students, pathologists and patients all have to be on board with a more judicious philosophy, Parsons said.
The researchers have attempted to attack the issue from multiple angles. They ask medical students to study the drawbacks of unnecessary testing. They ask doctors and pathologists to stay up-to-date on the proven effectiveness of various tests.
They are also studying various technical solutions, such as an on-screen pop-up when a doctor orders a certain test and a weekly email that analyzes the amount of tests a doctor orders as compared with their peers.
"You don't want to inundate all the doctors who already spend so much time in front of their screens, which is why we need to be strategic and undergo thorough research before we just try things out," Wiencek said.
For pathologists, Wiencek would like to see a “laboratory formulary” so pathologists and technicians can look back and see which types of tests are ordered and under what conditions.
UVa is considering a system that would analyze electronic health records and identify trends of frequent testing among various groups of doctors, according to the university. A laboratory stewardship committee, co-chaired by Wiencek, can then look at that data and try to find best approaches and practices for helping clinicians make better use of lab tests.
“It’s all about the right tests at the right time for the right patient,” Wiencek said.
In the end, though, the researchers said, any effort to control unnecessary tests must attack the issue from multiple angles and take its cue from the physician’s code of “do no harm.”
“You really have to hit it from all sides,” Wiencek said. “Anything we can do to make people stop and think and really make sure it’s the right thing is good.”