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Date sent: Thu, 24 Sep 1998 08:55:59 +0200 Subject: Clinical Problems in Office Practice From: [log in to unmask] (Sten Ohman) To: [log in to unmask] Send reply to: [log in to unmask] (Sten Ohman) An opinion as requested : 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"? 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. > How many treatments are delayed because the clinician does not request a > specific test? How much concern does it cause the patients when the he/she > does not get a clear diagnosis, maybe for several years? > greater interest: > > Why are tests NOT ordered? > > Several clinical chemists have spent a half life in inventing and > improving diagnostic methods and then nobody reqeusts these tests. Most of > these methods are highly specific and, if used, they could save a lot of > money for the tax-payers and avoid still more suffering for the patients. > > How many treatments are delayed because the clinician does not request a > specific test? How much concern does it cause the patients when the he/she > does not get a clear diagnosis, maybe for several years? > > The international codelist of lab methods contains about 8000 methods, of > which a few hundred are well-known. Probably there are at least as many > methods not listed but nevertheless valueable in a specific clinical > situation. > > In my opinion this is a matter of information: The clinicians must be > aware of the repertoire of laboratory medicine and they must get IT tools > for finding infrequent but, i the specific clinical situation, effective > diagnostic methods. > > The international codelist is a good start of such a tool. The IFCC should > take the initiative to develop an international database, where physicians > of all specialities (not only primary care) can lookup which method or > combination of methods is most effective in any clinical situation. > > Furthermore, borders must not be considered! Any laboratory in the world > fulfilling the appropriate quality should receive samples from any > hospital in any country! > > Clinical chemists, patients and taxpayers should all gain if laboratory > medicine could change to an international, free market, free from any > administrative or psychological restrictions! > > Maybe this thought is utopic at present - but nevertheless, it should be > discussed! %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%