The Unnecessary Test

My daughter left a stack of dirty plates outside her room last night like you might at a hotel. The dog licked them clean and even brought one to the kitchen. “Would you like the turn-down service too?” I quipped. “I have 2 tests and a quiz tomorrow for the second time this week,” Sophie lamented with that bashful face she knows I cave to. Maybe we need one of those tins that lab offices use for specimen pick up. Like schools, the healthcare system seems to order a lot of tests and the question is how many are actually necessary.  A poll we did a few years ago found that the clinical utility of lab tests varies – that maybe 20-30% of the time physicians are ordering tests they probably don’t need to.  9 of 10 medical directors argue that the utility of lab testing will likely become clearer and more important as more physicians take risk—noting that with more at stake, physicians will demand more from the test result or report. Asked to weight how much of the time lab testing is helpful today, cardiologists and endocrinologists we polled say that lab testing helps ‘validate what they're doing or plan to do’ for about 43 out of every 100 patients on average, redirects or actually changes their treatment approach for one-third of patients, and is inconclusive or useless in 15%. For “high-risk patients lab testing doesn’t add much info for me,” one doctor said, and “borderline hormonal tests (like metanephrines, cortisol levels) are more confusing than helpful,” another warned. On the other hand, testing is very helpful to figure out fatigue in undiagnosed hypothyroidism or “when a BNP (brain natriuretic peptide) level redirects appropriate use of a diuretic.” I asked Soph about her tests on the way to school. “You ready?” She shrugged and said “if by ready you mean do I know the structure of the judicial branch and how to conjugate verbs in french, it’s a 50-50 shot.”