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High Value Testing

Wednesday, January 25, 2012 // Uncategorized

The Congressional Budget Office has estimated that up to 5% of the nation’s gross national product is spent on tests and procedures that do not improve patient outcomes.  Tests are necessary in the diagnosis and treatment of many diseases, but tests can beget more tests.  Sometimes tests can lead to other tests which may have side effects.  An example is a chest x ray which is ordered before surgery that shows a small nodule.  If there is not an old chest x ray to compare it with, sometimes the only way to prove that a nodule isn’t something serious, like cancer, is to biopsy it.

Biopsies can have complications, like bleeding or a collapsed lung which requires another surgical procedure to correct. A patient  may have a serious complication for something that never would have caused them a problem.The following table is a list of questions from an editorial by Christine Laine, MD, MPH, Editor in Chiefof  the Annals of Internal Medicine in the January 17th edition  which she recommends physicians should ask prior to ordering a test.

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