Ordering tests is easy, but a specialist's opinion may be more valuable

A specialist ought to be someone who, by virtue of training and experience, can assess and advise patients and referring doctors with the optimum—which often means the minimum—use of investigations. A specialist whose main function is ordering tests is simply acting as a middle man (or woman) between the general practitioner and the service department, and such intermediaries can usually be dispensed with. With open access to hospital investigations general practitioners can dispense with some specialists, and, unsurprisingly, open access has not been universally welcomed as a proper means of offering health care.

Of course, some investigations must be reserved for specialists. These include invasive procedures entailing risk and requiring dexterity and those that are either very expensive or very time consuming (and hence need rationing by specialists, who know which patients are most likely to benefit). Few doctors want open access cardiac catheterisation for patients with chest pain or open access computed tomography for patients with headaches. But there seems no reason to deprive general practitioners of open access to techniques that are non-invasive, harmless, reliable, and cheap and can be carried out by a technician. For patients with cardiovascular problems the value of both open access exercise testing and echocardiography has been described.

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