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. 2002 Dec;52(485):974–980.

Understanding laboratory testing in diagnostic uncertainty: a qualitative study in general practice.

Trudy van der Weijden 1, Marloes A van Bokhoven 1, Geert-Jan Dinant 1, Cathelijne M van Hasselt 1, Richard P T M Grol 1
PMCID: PMC1314466  PMID: 12528582

Abstract

BACKGROUND: Better knowledge of the professional's motives for ordering laboratory tests in the case of diagnostic uncertainty may lead to interventions directed at reducing unnecessary testing. AIM: To gain insight into the general practitioner's (GP's) motives for ordering laboratory tests for patients presenting with unexplained complaints. DESIGN OF STUDY: Semi-structured interviews based on surgery observations. SETTING: Twenty-one general practices in rural and urban areas of The Netherlands. METHOD: Investigation of the GP's perception of determinants of test-ordering behaviour in the situation of diagnostic uncertainty. The interviews were structured by evaluating the consultations and test-ordering performance of that day. RESULTS: Dutch GPs vary considerably in their motives for ordering tests. Numerous motives emerged from the data. Some examples of important themes include: personal routines; tolerance of diagnostic uncertainty; time pressure; and tactical motives for test ordering. Complying with the perceived needs of the patient for reassurance through testing is seen as an easy, cost- and time-effective strategy. A clear hierarchy in the determinants was not found. CONCLUSION: The decision to request laboratory testing is the result of a complex interaction of considerations that are often conflicting. Designers of interventions meant to improve the ordering of tests should be aware of the numerous determinants, and take contextual variables into account.

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Selected References

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  1. Baker R. Is it time to review the idea of compliance with guidelines? Br J Gen Pract. 2001 Jan;51(462):7–7. [PMC free article] [PubMed] [Google Scholar]
  2. Berg M. Problems and promises of the protocol. Soc Sci Med. 1997 Apr;44(8):1081–1088. doi: 10.1016/s0277-9536(96)00235-3. [DOI] [PubMed] [Google Scholar]
  3. Britten N., Stevenson F. A., Barry C. A., Barber N., Bradley C. P. Misunderstandings in prescribing decisions in general practice: qualitative study. BMJ. 2000 Feb 19;320(7233):484–488. doi: 10.1136/bmj.320.7233.484. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bugter-Maessen A. M., Winkens R. A., Grol R. P., Knottnerus J. A., Kester A. D., Beusmans G. H., Pop P. Factors predicting differences among general practitioners in test ordering behaviour and in the response to feedback on test requests. Fam Pract. 1996 Jun;13(3):254–258. doi: 10.1093/fampra/13.3.254. [DOI] [PubMed] [Google Scholar]
  5. DeKay M. L., Asch D. A. Is the defensive use of diagnostic tests good for patients, or bad? Med Decis Making. 1998 Jan-Mar;18(1):19–28. doi: 10.1177/0272989X9801800105. [DOI] [PubMed] [Google Scholar]
  6. Dowell J., Pitkethly M., Bain J., Martin S. A randomised controlled trial of delayed antibiotic prescribing as a strategy for managing uncomplicated respiratory tract infection in primary care. Br J Gen Pract. 2001 Mar;51(464):200–205. [PMC free article] [PubMed] [Google Scholar]
  7. Hartley R. M., Charlton J. R., Harris C. M., Jarman B. Influence of patient characteristics on test ordering in general practice. Br Med J (Clin Res Ed) 1984 Sep 22;289(6447):735–738. doi: 10.1136/bmj.289.6447.735. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hartley R. M., Charlton J. R., Harris C. M., Jarman B. Patterns of physicians' use of medical resources in ambulatory settings. Am J Public Health. 1987 May;77(5):565–567. doi: 10.2105/ajph.77.5.565. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kristiansen I. S., Hjortdahl P. The general practitioner and laboratory utilization: why does it vary? Fam Pract. 1992 Mar;9(1):22–27. doi: 10.1093/fampra/9.1.22. [DOI] [PubMed] [Google Scholar]
  10. Owens D. K. Defensive diagnostic testing--a case of stolen utility? Med Decis Making. 1998 Jan-Mar;18(1):33–34. doi: 10.1177/0272989X9801800108. [DOI] [PubMed] [Google Scholar]
  11. Salmon P. Patients who present physical symptoms in the absence of physical pathology: a challenge to existing models of doctor-patient interaction. Patient Educ Couns. 2000 Jan;39(1):105–113. doi: 10.1016/s0738-3991(99)00095-6. [DOI] [PubMed] [Google Scholar]
  12. Schers H., Braspenning J., Drijver R., Wensing M., Grol R. Low back pain in general practice: reported management and reasons for not adhering to the guidelines in The Netherlands. Br J Gen Pract. 2000 Aug;50(457):640–644. [PMC free article] [PubMed] [Google Scholar]
  13. Wensing M., van der Weijden T., Grol R. Implementing guidelines and innovations in general practice: which interventions are effective? Br J Gen Pract. 1998 Feb;48(427):991–997. [PMC free article] [PubMed] [Google Scholar]
  14. Wileman Lindsey, May Carl, Chew-Graham Carolyn A. Medically unexplained symptoms and the problem of power in the primary care consultation: a qualitative study. Fam Pract. 2002 Apr;19(2):178–182. doi: 10.1093/fampra/19.2.178. [DOI] [PubMed] [Google Scholar]
  15. Zaat J. O., van Eijk J. T. General practitioners' uncertainty, risk preference, and use of laboratory tests. Med Care. 1992 Sep;30(9):846–854. doi: 10.1097/00005650-199209000-00008. [DOI] [PubMed] [Google Scholar]
  16. van Merode G. G., Stroink A. E., Maarse J. A., Goldschmidt H. M. Impact of insurance coverage type on laboratory test ordering behaviour of general practitioners. World Hosp Health Serv. 2000;36(3):7-12, 36-7. [PubMed] [Google Scholar]

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