Posted by Sten Westgard, BS
I've been meaning to draw attention to a paper from last year's Annals of Clinical Biochemstry for some time. Now's the moment:
The authors conducted a small survey of postgraduate doctors at the Sheffield Teaching Hospitals in the UK, in their foundation years (similar to the residency years of postgraduate doctors in the US). This study asked the doctors if they were confident about ordering 12 different types of tests (for example, proteins, calcium, lipid profile, urea and electrolytes). Then they also asked the doctors if they were confident about interpreting the results of those same 12 different types of tests.
It's worth looking at the results in detail of the actual paper, but let's summarize by saying those results are not ideal. While it's probably not surprising to find that the doctors felt more confident in ordering the tests than in interpreting the results, it's concerning to see the extent of their uncertainty. What does it mean when a doctor is only "usually confident" or not confident about requesting a test? Are they placing that test order just because other doctors do it? Are they ignorant of the utility of the test?
It is very striking that the study reports "18% of doctors were confident in requesting tests that they were not confident in interpreting." This is quite the bravado: I don't know how to interpret the results, but I have no problem ordering the test.
I don't think this is a particular reflection on UK doctors. If such a study was conducted somewhere else, I would expect similar, maybe even worse, results. Doctors tend to learn by doing about test results, but a certain number of tests seem to get ordered defensively or simply out of tradition.
This is another example where the laboratory can provide additional value - not only report the numbers, but help interpret the results, and perhaps even suggest what other tests might be a good idea to order next.
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