For doctors to effectively diagnose patients, the use of clinical laboratory tests can be essential. But new research recently published in The Journal of the American Board of Family Medicine finds that doctors often face uncertainty in ordering and interpreting clinical laboratory tests.
The research team, including Dr. John Hickner of the University of Illinois at Chicago College of Medicine and researchers from the Centers for Disease Control and Prevention (CDC), says their findings suggest doctors would welcome better technology and clinical decision support systems.
Primary care physicians order laboratory tests during 30-40% of outpatient encounters. But in the past 20 years, the number of laboratory tests available to doctors has more than doubled to at least 3,500.
“This complexity presents physicians with increasing challenges in accurately ordering and interpreting diagnostic tests and effectively using the results,” the study authors write.
With this in mind, the research team wanted to determine to what extent these doctors face difficulties with the growing array of laboratory tests available to them.
They conducted a survey of general internal medicine and family medicine physicians. All physicians were asked about:
- Their uncertainty in ordering and interpreting tests
- The tactics they used to overcome this uncertainty
- Factors that influence laboratory test ordering
- Challenges in appropriate ordering and interpreting of diagnostic laboratory tests, and
- Possible solutions that may improve ordering and interpreting tests.
The 1,768 primary care physicians who responded to the survey reported seeing an average of 81 patients per week. Diagnostic laboratory tests were ordered for 31.4% of these patients.
The doctors revealed that 14.7% of the time, they experienced uncertainty about ordering tests, and they experienced uncertainty in interpreting the results 8.3% of the time.
The absence of information about patient costs led to uncertainty in 53% of physicians. Insurance restrictions led to uncertainty in 40% of physicians, while different names for the tests led to uncertainty in 20% of doctors.
Commenting on the findings, Dr. Hickner says:
“The optimal testing pathways to arrive at correct diagnoses is changing, so it is difficult for primary care physicians to keep up with new and efficient testing algorithms.
This is a situation that clearly fosters uncertainty, so the results of the survey are not all that surprising.”
More than 500 million patients in the US visit primary care physicians each year. If laboratory tests are ordered for 31.4% of these patients – the equivalent to 157 million – the levels of physician uncertainty reported in this study could affect the ordering of tests for 23 million patients and the interpretation of tests for 13 million patients every year.
“This level of uncertainty raises significant concerns about the safety and efficient use of laboratory testing resources,” the researchers add.
The researchers note that many physicians have created their own strategies for ordering and interpreting laboratory tests. These range from asking a colleague or specialist, to calling the laboratory directly.
But the survey revealed that more than 50% of physicians would find improved information technology solutions useful in reducing uncertainty.
“Our survey results suggest that many physicians are ready to embrace sophisticated electronic clinical decision support tools,” the researchers write.
“Improved ordering methods, improved reporting formats, and access to laboratory consultation are potential ways to lessen uncertainty about ordering laboratory tests and interpreting the results.”
The study authors conclude that doctors, laboratory professionals and bioinformatic experts could team up to create electronic tools that address the challenges identified in their study, “thus enhancing the safety, effectiveness, efficiency, and timeliness and decreasing the cost of clinical laboratory testing.”
This is not the only study to note the pitfalls of the increasing variety and number of laboratory tests. Last year, Medical News Today reported on a study revealing that one third of doctors miss electronic tests results due to the large volume they receive.