We Live in Testing Times: Teaching Rational Test Ordering in General Practice
May 1, 2014: Pathology, imaging and other investigations have a critical role in the diagnosis, monitoring and screening for disease in medical practice. Reference books of medical tests are at least as old as the Hippocratic Corpus. The number of available tests has risen rapidly in recent decades and the Royal College of Pathologists of Australasia manual now lists over 750 individual tests. The use of laboratory and imaging tests is increasing in many countries. In Australia, the number of Medicare-funded pathology tests increased by 54% from 2000–2001 to 2007–2008, a volume increase from 62.1 million to 95.7 million tests. Over this period, pathology costs increased from $1.2 billion to almost $1.9 billion. General practitioners (GPs) are responsible for initiating 70% of Medicare-funded pathology tests.
While much of this increase is appropriate, a growing body of evidence suggests that over-testing is a significant problem. Australian data suggest that pathology testing does not always align well with recommended guidelines and 25–75% of tests are not supported by evidence or expert opinion. Concerns have been raised about the inappropriate use of many common tests, including full blood count (FBC), liver function tests (LFTs), B12/folate, thyroid function tests (TFTs), vitamin D, prostate-specific antigen (PSA), screening mammography, lumbar spine X-rays and shoulder imaging.
Royal Australian College of General Practicioners
Australian Family Physician (AFP) – Cardiology