[log in to unmask] (sorry, neither real name nor country
was indicated) wrote:
>There isn't much evidence that many of the tests we already do contribute to
>outcome - where is the evidence that patients would gain from free-market
>access to the other "8000+ methods"?
This discussion deals with the very basic questions of clinical chemistry and
all other diagnostic specialities. At least in Sweden the clinicians have
been criticized because they are ordering "a lot of unnecessary tests".
Some clinicians have admitted that they often order tests mainly because of
gaining time to think: They see a patient - order a test - let him/her wait -
take a rapid glance at the answer - call the patient back - order a treatment.
In such cases the laboratory test serves as a "diagnostic placebo", which has
nothing to do with the science of laboratory medicine.
Like in other placebo situations, however, the test is not "unnecessary".
If used appropriately also such tests gain the patient.
The great majority of tests, however, are requested because of a real
diagnostic demand, and this demand is INFORMATION. That's what all
laboratories are selling.
If all clinicians could fathom the potential value of all 8000+ methods
he/she should simply request the most appropriate test from the laboratory
offering it within a reasonable time with a sufficient quality and to a decent
price.
In reality clinicians are aware of the value of only a fraction of the most
frequent laboratory methods. Often more expensive methods, e.g. MRI,
are used, not because they are scientifically well established in terms of
diagnostic sensitivity and specificity, but because "all others use them"
>
>The answer to the question below is "very often". However, most of these are
>due to failure to request the ordinary 100 or so tests we do or failure to
think
>about the patient --- not lack of access to tests. The real question is "How
>many delayed diagnoses of treatable disease are due to failure to request a
>specific very unusual test?" We don't seen too many of these, and even here I
>don't think a free-market physician driven process would necessarily improve
>matters for either patients or taxpayers.
Indeed there are a lot of failures to request the basic about 100 tests,
but this problem is of limited dignity and can be coped locally.
The great problem concerns rare methods, i.e. tests that are indicated
less than 5000 times per miljon inhabitants and year.
The first problem is to make the clinician aware of the value of such a
rare test. The second is to let him know where to send the sample.
This needs some kind of information database that does not exist today.
When you know which test to request, then you can lookup in Assay Finder
or similar databases, but what happens if you don't know that there
exists a specific test that should gain the patient?
Rare methods should not be performed locally. If a method is performed
less than 5000 times a year there is a considerable risk of technical
as well as medical mistakes. Furthermore, the investment costs are
payed by too few samples and the price will be high.
For many of the 8000+ methods whole countries are not sufficient to get
at least 5000 samples per year. Therefore this market should be free and
international.
The deleterious effects of protectionism were explained by the economists
nearly 100 years ago. Today protectionism is banned in ordinary business.
But in health service in general and hence also in laboratory medicine
protectionism is still well established.
I feel like standing in Speakers Corner with the placard:
Down with protectionism in laboratory service!
So let this discussion continue.
Best wishes
Mr Sten Öhman, PhD
[log in to unmask]
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From: Mr Sten Öhman, PhD
Postal address: p.o. Box 133, S-590 70 Ljungsbro, Sweden
E-Mail address: [log in to unmask]
Phone: int: +46 13 219020, nat: 013-219020
Fax: int: +46 13 219021, nat: 013-219021
Personal home page: http://hem1.passagen.se/stoh7971/
Company home page: http://www.elfinilab.se/
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