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Why Should We Be Concerned about Excessive Lab Testing?

As discussed in the first blog in this series, laboratory and pathology testing accounts for $60 billion or 4% of total health care costs. This percentage is predicted to increase with the rapid expansion of genetic testing.

Besides cost, unnecessary laboratory testing has the potential to cause both indirect and direct harm to patients. The more tests that are ordered, the greater the likelihood that a result will fall outside of the normal range. Reference ranges are usually set so that 95% of the healthy population falls within the reference range. This means that 5% of healthy individuals may fall outside of this range. If 20 laboratory tests are ordered, the probability of an abnormal result is 64%.

Once a patient has an abnormal result, the test may be repeated or a confirmatory test is ordered. The patient may be referred to a specialist and imaging or an invasive procedure may be performed. Both of these have inherent risks.

A procedure may be unnecessarily postponed while this insignificant result is being pursued. The physician’s attention may be diverted from the primary problem leading to a diagnostic error. Patients may even develop iatrogenic anemia from repeat blood draws. This chain of events increases cost, worry, discomfort and risk. 

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