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High-Value Testing Begins With a Few Simple Questions

Christine Laine, MD, MPH, Editor in Chief
[+] Article, Author, and Disclosure Information

Acknowledgment: The author thanks Drs. Cynthia Mulrow, Darren Taichman, and Sankey Williams for their thoughtful review of drafts of this editorial.

Potential Conflicts of Interest: Dr. Laine is employed by the ACP.

Requests for Single Reprints: Annals of Internal Medicine, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.

Ann Intern Med. 2012;156(2):162-163. doi:10.7326/0003-4819-156-2-201201170-00016
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In this issue, Qaseem and colleagues' commentary presents 37 scenarios that the authors believe represent clinical situations in which testing provides little or no value to the patient. The editorialist acknowledges that many readers will disagree with the items the authors list and presents common-sense questions that physicians should ask before ordering any test.

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Posted on January 17, 2012
Laraine, Crampton, Acupuncture, Traditional Chinese Medicine
Conflict of Interest: None Declared

I believe that we need to have clear standards for what the best raw resources are in herbal medicine (has a particular herb been harvested in the right manner, in the right season, under the right conditions?), and for appropriate and safe processing for optimum quality of the end product.

However, I believe the rush towards 'standardization', if applied to having an array of 'standard' products along the lines of the 'patent medicines' traditional in China, can be an expensive distraction from our true responsibility to provide a flexible pharmacopia for individual, custom, application--so that each patient receives the formula that is precise to their condition. Otherwise, we end up using a lot of herbs unnecessarily, and throwing our efforts into providing 'patents' that are perhaps close to useful but achieve only partial results, when true remedies might have been provided.

The planet is not endlessly able to provide unlimited resources of herbs if we go mindlessly into big pharma approaches for our natural medicines.

Conflict of Interest:

None declared

Posted on January 23, 2012
mary, rappazzo, MD
Conflict of Interest: None Declared

A question to ask is would an adequate history and physical answer the problem without further testing

Also ,am I more apt to order a test because of financial incentive ex. ultrasound,scan,lab etc in the office

How do I as an internist control overtesting by specialist and NPs,PAs and Hospitalists

That being said this article and the message it sends should be a major theme for ACP and we not only need to educate ourselves about this factor in cost escalation but our patients as well.

Conflict of Interest:

None declared

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