Reducing unnecessary preoperative testing
BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2022-070118 (Published 06 October 2022) Cite this as: BMJ 2022;379:e070118Linked Editorial
Sustainable practice: what can I do?
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Dear Editor,
Avoid unnecessary tests
The article (1) has exposed that unnecessary preoperative tests are more like a ritual and have acquired the status of a traditional culture in medical practice, despite voluminous evidence against its continuation. Accordingly, it has become that much more difficult to change it. In addition, to the barriers for change listed in the review article, there are a few more. One, battery of unnecessary tests gives a sense of assurance to the resident doctor, that in case he/she has missed something in the history and examination it may be picked up by the tests. And if not, one could try to defend the allegation of lapse by showing one's proactive approach of getting the tests done. Two, unlike patients in the developed countries, for their counter parts in developing countries, these tests could be the first in their life-time. So, they are more than willing to undergo these testes or more to know for sure that they are not having any other illness in addition to the surgical condition in question. But if a patient has to bear the costs of tests as Out-of-Pocket (OOP) expenses, which is known to push patients' households to poverty, it is neither legal nor ethical for the doctor to get the unnecessary tests done.
The development of multichannel automated analyzers becomes an easy tool to get a host of simple biochemical tests done in one go. But the down side is that if some test results are beyond normal ranges, then it poses potential challenges for interpretation which may lead to erroneous suspicion for hidden pathology demanding further investigations. More often, small variations in reports are ignored, and this could prove a potential mine filed for malpractice litigation if the patient suffers a complication, even if it is rare, because it is indefensible to justify why the report was ignored. This case scenario is avoidable by not doing the tests in the first place which could be easily defended on the ground that it is not clinically indicated based on current evidence.
References:
1. Dossett Lesly A, Edelman Anthony L, Wilkinson G, Ruzycki Shannon M. Reducing unnecessary preoperative testing. BMJ 2022;379:e070118
Competing interests: No competing interests
Re: Reducing unnecessary preoperative testing
Dear Editor
This issue remains a pressing concern for GPs in the UK, and their general practices which often host this activity.
A universal constant I discuss with GPs in training is that a doctor will request fewer blood tests if the doctor is asked to do his/her own phlebotomy.
Is it now economically and ecologically reasonable for the GP practice to decline requests to host this work if only to prompt some quality reflection from the clinical team requesting the tests?
Dr Will Howe
GP
Lostwithiel
Cornwall
Competing interests: No competing interests