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Are Physicians Taught Appropriate Test Ordering?

The first 3 blogs on this topic defined an unnecessary or inappropriate lab test and reviewed some of the literature illustrating the extent of lab test overuse. Many other publications have attempted to discover why physicians order too many laboratory tests. One of the primary reasons is that physicians are currently paid to do things. They have few incentives to order fewer tests.  Most practicing physicians never received formal training to order fewer tests.

Medical students are taught to do things, not how to know what not to do. In a typical medical school pathology course, medical students are taught more about the histology of a myocardial infarction than about troponin, the single best laboratory test to confirm an MI.

A pathologist from a prominent ivy league medical school observed that clinicians have minimal impact on house staff ordering patterns. Attending physicians believe that house staff does not need supervision for such a low risk diffuse activity. They also feel that autonomy in laboratory test ordering is necessary for refinement of clinical skills.  However, these attitudes indicate that attending physicians do not understand the impact of excessive laboratory testing on patients or the financial state of their health system.

The next blog will explore many of the other reasons that physicians order too many laboratory tests. 

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