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What is an Unnecessary Lab Test?

What is an inappropriate or unnecessary test?  It can be defined as any test where the results are not likely to be medically necessary for clinical management of the patient. It should NOT be solely defined as any laboratory test unlikely to be reimbursed.

Examples of inappropriate tests include legitimate tests ordered in an inappropriate clinical setting. Examples include ordering PSA screening for men 75 years and older, placing daily orders for the same analyte in noncritical patients and screening the general population for vitamin D deficiency. 

A second example is ordering laboratory tests that have weak evidence to support their clinical utility. Examples of these tests include IgG allergy tests,  Vertical Autoprofiler (VAP) for lipids, esoteric cardiovascular risk prevention profiles, expanded celiac disease panels and extensive patented neurologic panels.

A third example includes tests that represent pseudoscience lab profiles. Commonly marketed examples include oxidative stress analysis, estrogenomic profiles, detoxigenomic profiles , salivary hormone profiles for aging or menopause, and laboratory tests for chronic fatigue syndrome, fibromyalgia, autism, irritable bowel syndrome, chemical sensitivity and vaccine injury. 

In this age of decreasing reimbursement, excessive ordering of laboratory tests should be considered a waste of medical resources.

The next blog will attempt to uncover the magnitude of unnecessary laboratory testing

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