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The Abnormal Screening Laboratory Results: Its Effect on Physician and Patient

The Abnormal Screening Laboratory Results: Its Effect on Physician and Patient Abstract Increasing use of the automated chemical screening battery has magnified a problem which formerly was rare: what to do with an unexpectedly "abnormal" laboratory result. To assess the response of physicians to the appearance of a laboratory value outside the stipulated range of normal and its significance to patients, we reviewed computer-stored clinical data with written records of 547 patients seen in the Stanford University Hospital Medical Clinic. We found that physicians tended to pay little attention to "abnormal" results of screening battery laboratory tests, which, furthermore, led to positive diagnoses only infrequently during the period of observation of this sample of patients. Deviation from normal has both statistical and clinical meanings and can result from a variety of causes, of which the physician must be aware in order to make reasonable judgements. References 1. Schneiderman LJ, Baylor St M: Computer-assisted research of medical records: A facilitated access file for physical examination, laboratory and diagnostic data. Meth Inform Med 9:171-176, 1970. 2. Collen MF: Value of multiphasic health checkups. New Eng J Med 280:1072-1073, 1969.Crossref 3. Who's for screening? Lancet 2:706-707, 1967. 4. Screening and the practice of medicine. Lancet 2:83-84, 1967. 5. Prescriptive screening. Lancet 2:1065-1066, 1968. 6. Laboratory screening procedures and their clinical applications: A symposium. Proc Roy Soc Med 61:763-770,1968. 7. Screening in Medical Care: Reviewing the Evidence. New York, Oxford University Press for the Nuffield Provincial Hospitals Trust, 1968. 8. Wilson JMG, Jungner G: Principles and practices of screening for disease. WHO Public Health Pap 34:1-163, 1968. 9. Rardin TE: Laboratory profile screening in family practice. JAMA 214:1262-1268, 1970.Crossref 10. McCall MG: Normality. J Chronic Dis 19:1127-1132, 1966.Crossref 11. Murphy EA, Abbey H: The normal range: A common misuse. J Chronic Dis 20:79-88, 1967.Crossref 12. Files JB, Van Peenen HJ, Lindberg DAB: Use of "normal range" in multiphasic testing. JAMA 205:684-688, 1968.Crossref 13. Elveback LR, Guillier CL, Keating FR Jr: Health, normality and the ghost of Gauss. JAMA 211:69-75, 1970.Crossref 14. Feinstein AR: What kind of basic science for clinical medicine? New Eng J Med 283:847-852, 1970.Crossref 15. Elking MP, Kabat HF: Drug induced modifications of laboratory test values. Amer J Hosp Pharm 25:485-519, 1968. 16. Searcy RL: Diagnostic Biochemistry. New York, McGraw-Hill Book Co Inc, 1969. 17. Clark TW, Schor SS, Elsom KO, et al: The periodic health examination: Evaluation of routine tests and procedures. Ann Intern Med 54:1209-1222, 1961.Crossref 18. Collen MF, Kidd PH, Feldman R, et al: Cost analysis of a multiphasic screening program. New Eng J Med 280:1043-1045, 1969.Crossref 19. Ahlvin RC: Biochemical screening: A critique. New Eng J Med 283:1084-1086, 1970.Crossref 20. Halberstam MJ: The silent debits of multiphasic screening. New Eng J Med 283:1114, 1970. 21. Collen MF: Letter , New Eng J Med 283:1114-1115, 1970.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Abnormal Screening Laboratory Results: Its Effect on Physician and Patient

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Publisher
American Medical Association
Copyright
Copyright © 1972 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1972.00320010092011
Publisher site
See Article on Publisher Site

Abstract

Abstract Increasing use of the automated chemical screening battery has magnified a problem which formerly was rare: what to do with an unexpectedly "abnormal" laboratory result. To assess the response of physicians to the appearance of a laboratory value outside the stipulated range of normal and its significance to patients, we reviewed computer-stored clinical data with written records of 547 patients seen in the Stanford University Hospital Medical Clinic. We found that physicians tended to pay little attention to "abnormal" results of screening battery laboratory tests, which, furthermore, led to positive diagnoses only infrequently during the period of observation of this sample of patients. Deviation from normal has both statistical and clinical meanings and can result from a variety of causes, of which the physician must be aware in order to make reasonable judgements. References 1. Schneiderman LJ, Baylor St M: Computer-assisted research of medical records: A facilitated access file for physical examination, laboratory and diagnostic data. Meth Inform Med 9:171-176, 1970. 2. Collen MF: Value of multiphasic health checkups. New Eng J Med 280:1072-1073, 1969.Crossref 3. Who's for screening? Lancet 2:706-707, 1967. 4. Screening and the practice of medicine. Lancet 2:83-84, 1967. 5. Prescriptive screening. Lancet 2:1065-1066, 1968. 6. Laboratory screening procedures and their clinical applications: A symposium. Proc Roy Soc Med 61:763-770,1968. 7. Screening in Medical Care: Reviewing the Evidence. New York, Oxford University Press for the Nuffield Provincial Hospitals Trust, 1968. 8. Wilson JMG, Jungner G: Principles and practices of screening for disease. WHO Public Health Pap 34:1-163, 1968. 9. Rardin TE: Laboratory profile screening in family practice. JAMA 214:1262-1268, 1970.Crossref 10. McCall MG: Normality. J Chronic Dis 19:1127-1132, 1966.Crossref 11. Murphy EA, Abbey H: The normal range: A common misuse. J Chronic Dis 20:79-88, 1967.Crossref 12. Files JB, Van Peenen HJ, Lindberg DAB: Use of "normal range" in multiphasic testing. JAMA 205:684-688, 1968.Crossref 13. Elveback LR, Guillier CL, Keating FR Jr: Health, normality and the ghost of Gauss. JAMA 211:69-75, 1970.Crossref 14. Feinstein AR: What kind of basic science for clinical medicine? New Eng J Med 283:847-852, 1970.Crossref 15. Elking MP, Kabat HF: Drug induced modifications of laboratory test values. Amer J Hosp Pharm 25:485-519, 1968. 16. Searcy RL: Diagnostic Biochemistry. New York, McGraw-Hill Book Co Inc, 1969. 17. Clark TW, Schor SS, Elsom KO, et al: The periodic health examination: Evaluation of routine tests and procedures. Ann Intern Med 54:1209-1222, 1961.Crossref 18. Collen MF, Kidd PH, Feldman R, et al: Cost analysis of a multiphasic screening program. New Eng J Med 280:1043-1045, 1969.Crossref 19. Ahlvin RC: Biochemical screening: A critique. New Eng J Med 283:1084-1086, 1970.Crossref 20. Halberstam MJ: The silent debits of multiphasic screening. New Eng J Med 283:1114, 1970. 21. Collen MF: Letter , New Eng J Med 283:1114-1115, 1970.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1972

References