You may have noticed this at your last doctor’s appointment
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Here’s a weird lesson we learned from c19 supply shortages
Sometimes bad things have silver linings.
That’s the case with the COVID pandemic and blood tests.
Because of testing supply shortages, we are now producing fewer unneeded blood tests in the United States.
The United States is a testing heavy culture.
We like to test everything, even when we don’t need to and even when it doesn’t actually benefit anyone and just costs a whole lot of money.
That’s the case with tests called the PT/INR or prothrombin time test.
This is a test that’s used to find out if your blood is clotting normally.
A PT/INR test helps find out if your blood is clotting normally. It also checks to see if a medicine that prevents blood clots is working the way it should.
It’s a common test that’s often used in hospital settings, but until recently it was probably overused.
“There are very important reasons to order this test in some patients, for instance before an operation or when managing certain conditions and treatments,” Breeden explains. “But it may also be part of a standard order set that’s put in during an emergency department visit and continues to be ordered repeatedly after the patient is admitted to the hospital, even though the results won’t change their care.” For such patients, a one-time test might be indicated, but not repeated testing.
During the beginning of the COVID pandemic the supplies for these tests were in short supply and doctors were urged to think before ordering them.
After emailing all providers, U-M Health added a “best practices alert” to doctors’ test-ordering electronic system. They could still order PT/INR/PTT tests, but were asked for “thoughtful restraint in reflexive ordering.”
This simple alert asked doctors to restrain their orders of this test and the result has been a persistent 39% reduction in tests ordered.
In the new study, published in JAMA Internal Medicine, an alert led to a nearly immediate 29% drop in orders for one common test. The reduced level persisted for months.
My big takeaway from this is that a lot of what doctors do is reflexive.
That means that they will order a test because that’s the way it’s always been done.
Doctors are creatures of habit, just like all of us and what they recommend for you may be great…
…but it also may just be what they normally recommend in any given circumstance.
It’s wise to WORK with your doctor rather than just take every recommendation they tell without question.
Small questions can make a big difference in the quality of care you receive.
“This shows that small interventions can make a big difference, and suggests the potential for other types of low-value care to benefit from a similar intervention,” says lead author Madison Breeden, M.D., a fellow in infectious diseases at U-M Health who conducted the study during her year as chief resident of Quality and Patient Safety. She’s already exploring if the approach might reduce unnecessary prescribing of antibiotics.
Ultimately, your health is in your hands. If you want to be healthy you can’t rely on a doctor, a hospital, or anyone else to make you healthy.
Instead, you can (and should) investigate health options, figure out what works for you and work WITH your doctor on implementing changes in your life.
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