To diagnose, monitor, and prevent disease, doctors often rely on laboratory tests, which provide much more information than can be gleaned with the naked eye and hands. While the clinical utility of laboratory tests are undeniable, not every case warrants an extensive battery of lab tests. And for a team of doctors at the Medical College of Georgia at Augusta University, excessive testing happens all too often.
The team set out to determine whether over-testing was clinically beneficial. They examined the records of 237 patients age 19-87 who had a total of 1,503 episodes of testing. Specifically, these patients had a range of serum testing done to identify abnormal quantities of the M-protein antibodies in their blood, which could be indicative of the cancer multiple myeloma.
They found in nearly half the time, patients didn’t need an array of tests done. “About 40-50 percent of the second tests are not needed or adding value," said Gurmukh Singh, chief of the Section of Clinical Pathology and Walter L. Shepeard Chair in Clinical Pathology, and the study’s senior author.
Rather than ordering the array of test from the get-go, or ordering the tests multiple times, Singh proposes a more thoughtful, methodical approach. He suggests an initial workup to determine presence of the M-protein. Then, before ordering additional tests, the physicians should consider multitude of factors, including the quantity of the abnormal antibody and the patient’s medical history.
"These are stepwise things. If it's a new patient, do this; if it's a known patient, do that. Results drive it. That will reduce the number of tests that are done without in any way being of detriment to the patient or the quality of care," Singh said.
In his audit, Singh reported that the secondary testing was warranted in less than 50 percent of the time. But yet there were 1,503 tests ordered for 237 patients, which average to be over 6 tests per patient. If testing is done systematically instead of indiscriminately, the team estimates that their medical institution alone could have saved over $64,000 in one year in health care costs. The number quickly adds up to millions if multiplied by the many hospitals all around the nation. "It's better for patients and for health care delivery in general," Singh said.
Of course it’s not always so black and white. Physicians don’t always encounter “text-book” patients with clear-cut paths to diagnosis and treatment. And so the standby has always been to err on the side of caution and order more tests. But studies like this and others suggest that thoughtful evaluation of every test could save time, money, and distress for the patients.
Additional source: EurekAlert!