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How Physicians Use Laboratory Tests

How Physicians Use Laboratory Tests Abstract The aim of our study was to measure the ways in which a physician perceives and reacts to a laboratory result. After reviewing a series of brief clinical problems, physicians were asked to indicate the change in test results that would alter the diagnosis or treatment. Although there were wide differences in attitudes, the pattern of responses from 125 internists offered estimates of what is a clinically important change. In selected clinical settings, the change in successive measurements chosen with the greatest frequency as indicators of a clinically important change in level were glucose, 35 mg/dl; BUN, 6 mg/dl; serum sodium, 4 to 6 mEq/liter; serum potassium, 4 to 6 mEq/liter; uric acid, 8 mg/dl; creatinine, 0.4 mg/dl; serum calcium, 4 to 5 mg/dl; triglycerides, 20 mg/dl; hemoglobin, 1 g/dl; and serum osmolality, 11 mOsm/kg. The responses were compared with estimates of laboratory precision drawn from a national quality control program. The quality of laboratory testing was rated as satisfactory for clinical use in four of five clinical settings. The study points out the need to correlate the activities in the clinical laboratory with the application of test results in the care of patients. (JAMA 239:1077-1080, 1978) References 1. Cole GW: Clinical usefulness of multiple result ranges for a laboratory test: the serum urea nitrogen . Report to the Guidelines for Appropriate Utilization of Laboratory Procedures Committee, College of American Pathologists, Skokie, Ill, (Sept 16) , 1976. 2. Barnett RN: Medical significance of laboratory results : Am J Clin Pathol 50:671-676, 1968. 3. Williams GZ, Harris EK, Widdowson GM: Comparison of estimates of long-term analytical variation derived from subject samples and control serum . Clin Haematol 23:100-104, 1977. 4. Zieve L: Misinterpretation and abuse of laboratory tests by clinicians . Ann NY Acad Sci 134:563-572, 1966.Crossref 5. Krieg AF, Gambino R, Galen RS: Why are clinical laboratory tests performed? When are they valid? JAMA 233:76-78, 1975.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

How Physicians Use Laboratory Tests

JAMA , Volume 239 (11) – Mar 13, 1978

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References (7)

Publisher
American Medical Association
Copyright
Copyright © 1978 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.1978.03280380077027
Publisher site
See Article on Publisher Site

Abstract

Abstract The aim of our study was to measure the ways in which a physician perceives and reacts to a laboratory result. After reviewing a series of brief clinical problems, physicians were asked to indicate the change in test results that would alter the diagnosis or treatment. Although there were wide differences in attitudes, the pattern of responses from 125 internists offered estimates of what is a clinically important change. In selected clinical settings, the change in successive measurements chosen with the greatest frequency as indicators of a clinically important change in level were glucose, 35 mg/dl; BUN, 6 mg/dl; serum sodium, 4 to 6 mEq/liter; serum potassium, 4 to 6 mEq/liter; uric acid, 8 mg/dl; creatinine, 0.4 mg/dl; serum calcium, 4 to 5 mg/dl; triglycerides, 20 mg/dl; hemoglobin, 1 g/dl; and serum osmolality, 11 mOsm/kg. The responses were compared with estimates of laboratory precision drawn from a national quality control program. The quality of laboratory testing was rated as satisfactory for clinical use in four of five clinical settings. The study points out the need to correlate the activities in the clinical laboratory with the application of test results in the care of patients. (JAMA 239:1077-1080, 1978) References 1. Cole GW: Clinical usefulness of multiple result ranges for a laboratory test: the serum urea nitrogen . Report to the Guidelines for Appropriate Utilization of Laboratory Procedures Committee, College of American Pathologists, Skokie, Ill, (Sept 16) , 1976. 2. Barnett RN: Medical significance of laboratory results : Am J Clin Pathol 50:671-676, 1968. 3. Williams GZ, Harris EK, Widdowson GM: Comparison of estimates of long-term analytical variation derived from subject samples and control serum . Clin Haematol 23:100-104, 1977. 4. Zieve L: Misinterpretation and abuse of laboratory tests by clinicians . Ann NY Acad Sci 134:563-572, 1966.Crossref 5. Krieg AF, Gambino R, Galen RS: Why are clinical laboratory tests performed? When are they valid? JAMA 233:76-78, 1975.Crossref

Journal

JAMAAmerican Medical Association

Published: Mar 13, 1978

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