While the potential benefits of better patient-physician communication in this litigious society are great, the burden of informed consent rests heavily on physicians. 3,4 Decision analysis incorporates all potential benefits and costs. It has shown that implementation of the ACOG guideline is associated with the highest number of pregnancy losses associated with amniocentesis and the highest cost per case detected. Screening all women first with the triple analyte test has a 20 percent lower cost and almost one half the number of pregnancy losses associated with amniocentesis. In addition, the detection rate of the triple analyte test is strongly age-dependent.
Older patients accrue the greatest benefits of screening.
There are low benefits or even negative effects associated with screening in younger patients. Differences in technical accuracy limit the widespread use of this type of ultrasonography. With the proliferation of new genetic tests that detect carriers of genes that cause and predispose to disease, genetic testing will likely become a much bigger part of primary care practice. The impact on our practices may be profound. Family physicians must play a leadership role in the creation of guidelines for genetic testing that take into account all costs and benefits and in the promotion of skills that enhance communication and shared decision-making with our patients.