Erroneous laboratory results

Jason Maude jason.maude at ISABELHEALTHCARE.COM
Fri May 27 09:54:55 UTC 2016


How is it the profession has ended up placing such reliance on an aspect which is shown to contribute so little and cost so much?

This study backs up the old adage that 80% of the diagnosis is given by the history and physical with relatively little contributed by tests
http://archinte.jamanetwork.com/article.aspx?articleid=1106285

To paraphrase Churchill, never in an industry has so much been shown to contribute so little for so much expense!

Regards
Jason Maude


From: Tom Benzoni <benzonit at GMAIL.COM<mailto:benzonit at GMAIL.COM>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Tom Benzoni <benzonit at GMAIL.COM<mailto:benzonit at GMAIL.COM>>
Date: Wednesday, 25 May 2016 17:08
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: Re: [IMPROVEDX] Erroneous laboratory results

I'm a "thin" lab tester and 90% of what I order I don't need.
My junior confreres order easily double my volume.
Same outcomes narrowly defined; fully defined, worse outcomes.
(I don't order d-dimer on patients without at least moderate likelihood PEs or DVT. My junior guys do so routinely and so do many more CTA and U/S. We have the same rate of final diagnoses. But I (likely) have fewer renal failures (we don't see followup) and fewer bankruptcies.

Take, for example, ABGs. They are rarely needed; the same data is available venously and from already done tests (BMP/MGA/SMA7), pulse ox and EtCO2, yet I see 40% of our ICU tests are ABG.
CBC with diff when most folks can't interpret the diff but don't know they can't. CBC without diff when you only need the Hgb.
EKG in my shop is an excellent predictor that you do NOT have ACS.
All LPs go to IR.

I could go on.

So overtesting is huge.

tom benzoni

On Wed, May 25, 2016 at 10:20 AM, Cameron Powell <cameron at physiciancognition.com<mailto:cameron at physiciancognition.com>> wrote:
Perhaps some of you have already seen this study on under- and over-testing.


“First we found that the rate of overuse, meaning [medical laboratory] tests that we performed that shouldn’t have been performed, average around 20%. That means out of every 10 tests ordered about two tests on average should not have been ordered.

“Even more surprising was the rate of underuse [of medical laboratory tests]. This is the rate of tests that should have been ordered in a given time but weren’t ordered. That rate was over 40%. So, for every three tests performed, an additional two tests should have been ordered.”

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0078962

We’ve taken a run at solving suboptimal testing strategies and it’s going very well. We’ll keep you posted on our progress.

Cameron



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On May 20, 2016, at 12:40 PM, DR WILLIAM CORCORAN <williamcorcoran at SBCGLOBAL.NET<mailto:williamcorcoran at sbcglobal.net>> wrote:

What do you think of the YouTube video and the comments posted?

WSJ journalist John Carreyrou shares year-long Theranos investigation & breaks latest, stunning news<https://youtu.be/zSgwJA-GOlg>




[image]<https://youtu.be/zSgwJA-GOlg>











WSJ journalist John Carreyrou shares year-long Theranos ...<https://youtu.be/zSgwJA-GOlg>


View on youtu.be<https://youtu.be/zSgwJA-GOlg>

Preview by Yahoo






Take care,

Bill Corcoran


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https://www.box.com/shared/kfxg1lt9dh



On Friday, May 20, 2016 11:10 AM, Dwight Oxley <dwight.oxley at GMAIL.COM<mailto:dwight.oxley at gmail.com>> wrote:


The link below details how a large number of erroneous results were reported from a commercial medical laboratory. This report is just the latest in the Wall Street Journal’s coverage of the Theranos Co. Lab results account for more than 50% of the information in a medical record, thus the impact of these is enormous.

Dwight Oxley


http://on.wsj.com/1TpKiL3

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