National survey of 1,768 family practice and internal medicine specialists determines that they are struggling to stay current with changing guidelines for ordering and interpreting medical laboratory tests

Recent publication of a new study confirms what pathologists and medical laboratory professionals have known for years: a significant number of primary care physicians acknowledge that they sometimes are uncertain about which clinical laboratory test is the most appropriate one to order. These same doctors also admit that they are often also uncertain how to interpret the results of some medical laboratory tests.

Physicians Uncertain when Ordering Clinical Laboratory Tests

These are two conclusions resulting from a survey published in the March-April edition of the Journal of the American Board of Family Medicine (JABFM). It is important that clinical laboratory administrators and pathologists understand the survey findings for two important reasons.

First, as reimbursement moves away from fee-for-service to other forms—such as bundled payment and per-patient-per month—laboratory managers will need to deal with the problem of unnecessary utilization of medical laboratory tests. Second, the findings of this survey suggest an opportunity for pathologists and lab administrators to improve the utilization of lab test resources by streamlining systems and opening or improving communication channels with the doctors.

Survey Points to Physicians’ Being Overloaded with Clinical Test Options

The study’s purpose was to reveal challenges and solutions primary-care doctors perceive in ordering and interpreting clinical laboratory tests. Titled ”Primary Care Physicians’ Challenges in Ordering Clinical Laboratory Tests and Interpreting Results,” this national survey was completed in 2011. Sponsored the Centers for Disease Control and Prevention, the study involved 1,768 internal medicine and family practice specialists.

Since the mid-1990s, the number of medical laboratory tests available to doctors has doubled to more than 3,500, the study reported. Each primary-care physician sees an average of 81 patients per week, and they order lab tests for about a third of them, a University of Illinois at Chicago (UIC) news release stated. The survey was conducted by UIC researchers.

Doctors Uncertain 15% of the Time When Ordering Tests

Doctors are uncertain about ordering lab tests 15% of the time, and they are uncertain about interpreting the results 8% of the time, the study showed. This may be a small proportion of lab test orders, but multiplied by the thousands of physicians practicing medicine throughout the nation, this represents a very large number of clinical lab tests. Further, this level of uncertainty may potentially affect 23 million patients annually, the researchers concluded. That is also a big number.

Changes to evidence-based medicine and optimal testing pathways are happening at such a fast pace that primary-care physicians are finding it difficult to keep up with new and efficient testing algorithms, noted John Hickner, M.D. (pictured above), Professor and Head of family medicine at the University of Illinois at Chicago College of Medicine. He was the corresponding author of the published study about how primary-care physicians utilize clinical laboratory tests. (Photo copyright University of Illinois at Chicago.)

Sources of Confusion Range from Test Names to Costs

As to what causes their uncertainty, primary-care doctors responded as follows:

  • Absence of information about patient costs (53%)
  • Insurance restrictions (40%)
  • Different names for the same test (20%)

Missing lab test results and confusing report formats were other challenges perceived by the doctors. This suggests an opportunity for clinical laboratories to improve and enhance lab test reporting procedures to help physicians get optimal value from test results.

In addition, clinical laboratories should improve their electronic test ordering capabilities by adding features that show physicians medical laboratory test costs and patient insurance deductibles before physicians order tests.

Offering Better Access to Pathologists to Help Reduce Doctors’ Uncertainties

There are still other ways to address doctors’ uncertainties.

The study suggests that giving physicians greater access to pathologists and laboratory staff can help reduce uncertainties regarding which lab tests to order and how to interpret results. However, just 6% of the doctors studied said they reached out to clinical laboratory professionals for help on a weekly basis. When they did, they found the consultation helpful.

The percentage of doctors reporting laboratory communication very or extremely helpful ranged from 37% to 65%. When physicians consulted with pathologists and clinical laboratory staff, the reasons for the consultations included:

• scientific opinion of significance of lab test results (4%);

• status of missing results (26%).

Consulting with Pathologists and Medical Laboratory Personnel

“Consultation with pathologists and laboratory personnel could also be a rapid and cost-effective method for reducing uncertainty about test ordering and interpretation,” the researchers wrote.

“Primary care providers should have convenient access to laboratory physicians to assist in laboratory test ordering and interpretation. Laboratory managers and pathologists should develop better communication channels with busy physicians to make consultation services easily available. This could improve patient care through more appropriate laboratory utilization and potentially reduce costs by avoiding specialist referrals solely for test interpretation,” the JABFM writers continued.

In keeping with this recommendation, some providers have devoted attention to how clinical laboratory test reports are communicated to referring physicians. For example, a recent Dark Daily shared a study that suggested a simple change in how a hospital laboratory reports test results can reduce urine culture tests and unneeded antibiotic prescriptions. (See Dark Daily, “Study Shows How Simple Changes in Reporting Medical Laboratory Test Results to Clinicians Improve Patient Safety and Reduce Inappropriate Use of Antibiotics,” April 6, 2014.)

Making It Easy for Physicians to Engage with the Clinical Lab

In many ways, the authors of the JABFM  study are singing the same tune as that of pathologists. “Improved ordering methods, improved reporting formats, and access to laboratory consultation are potential ways to lessen uncertainty about ordering laboratory tests and interpreting the results,” wrote the researchers.

Pathologists and clinical laboratory managers might want to consider using this study as a base for launching a communication plan focused on educating primary-care doctors about three aspects of lab testing: improved lab test ordering, help on lab test interpretation, and more information about the costs of specific lab tests. Outreach by the laboratory staff can built relationships with the doctors and possibly reduce the number of unnecessary tests.

—By Donna Marie Pocius

Related information

Primary Care Physicians’ Challenges in Ordering Clinical Laboratory Tests And Interpreting Results

Doctors Often Uncertain in Ordering, Interpreting Lab Tests

Study Shows How Simple Changes in Reporting Medical Laboratory Test Results to Clinicians Improved Patient Safety & Reduce Inappropriate Antibiotics