Reducing the Burden of False-Positive Tests: It Is Time to Optimize Diagnostic Testing for Undifferentiated Conditions

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Mayo Clinic Proceedings

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Overtesting is common, often occurring as “shotgun” testing.1,2 In contrast to a directed hypothesisfocused evaluation, shotgun testing is the routine use of extensive testing for patients with an undifferentiated condition during the initial assessment.1,2 It occurs as a convention or even a reflex; that is, elevated liver enzyme levels trigger a “full liver work-up”; arthritis needs a “rheumatology panel.” It is a strategy with little consideration of pretest probabilities and is out of sync with ideal or responsible diagnostic testing. Shotgun testing is also costly. Costs may be measured in health care dollars, but may also be personal because shotgun testing increases false-positive results,1 which in turn may cause a cascade of additional testing and patient or provider stress.1,3,4 Although modern medical care strives toward precision and personalization, shotgun testing is imprecise and impersonal. Furthermore, shotgun testing inappropriately reduces the act of diagnosis to the ordering of test panels and such a practice may compromise the development of the diagnostic acumen of future physicians. As noted by Simpkin et al,5 a test first, think later strategy neither improves one’s diagnostic reasoning nor handling of uncertainty.


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