That this is more true in teaching than in nonteaching hospitals has been axiomatic. In their study of first-year medical residents, Yarold and associates 1 found that an increased level of didactic knowledge was an independent predictor of increased laboratory use, while a high level of clinical judgment was an independent predictor of decreased use. This finding is as expected. Physicians, both house staff and attending staff, may use the laboratory inappropriately because medical education does not teach effective methods of testing but rather emphasizes traditional disease-oriented subject matter. The result is overordering to avoid the possible embarrassment of missing something that a supervisor might think important.
Physicians order tests for many reasons.
Over a 5-year period, Lundberg 2 collected a list of 34 reasons. Those most frequently mentioned were diagnosis, prognosis, screening, monitoring, curiosity, research, and habit. Yet, in spite of the popularity of testing, some authors 3 have suggested that its value in diagnosis and management is overrated. Any such system would be far from perfect, create much resentment, be prone to error, and in itself add another layer of inefficiency to the testing process. The pathologist certainly has a role in the overall process of optimizing test use.