Over-testing is at the root of many of our problems. Ordering, reviewing, and interpreting tests, explaining results, and follow-up testing consume valuable time. When a test isn’t necessary, time can be more appropriately spent counseling patients, listening to them, and redoubling efforts to follow well-supported preventive guidelines.
Over-testing may be defined as the use of: 1) nonrecommended screening tests in asymptomatic patients, or 2) more testing than necessary to diagnose patients with signs or symptoms. This discussion explores reasons physicians over-test, problems that ensue, and describes viable solutions for practitioners and primary care and specialty societies. Discussion is confined to the outpatient setting to simplify this analysis.
There are at least 5 reasons why clinicians over-test:
1)Belief that ordering many tests will help detect subclinical disease
2)Defensive medicine
3)Lack of knowledge or confidence
4)Patients’ expectations
5)Profit
When ordering unproven screening tests for asymptomatic patients without good reason, few consider the low yield, high cost per diagnosis made, and considerable toll of false positives. Anecdotal accounts of unexpected diagnoses discovered on “routine” testing help perpetuate over-testing. But even the best tests yield more false positives than true positives when the prevalence of what one is testing for is low. Others order tests to establish a “baseline,” but this has been shown repeatedly not to improve care for asymptomatic patients and consumes hundreds of millions of health care dollars per year.1, 2 Abnormal results that later prove erroneous engender unnecessary anxiety and needless follow-up testing. Ordering only medically indicated tests reduces our role as instigators of needless worry and, as an added benefit, helps lessen physicians’ workload.
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–Jerome Greenberg, MD, Jonas B. Green, MD, MPH, MSHS
This article originally appeared in the May 2014 issue of The American Journal of Medicine.
