Breaking News: Lowly Interns Order More Tests!

Lowly interns order more tests! Tell us something we don’t know.

All sarcasm aside, it is a well known fact that interns, largely due to inexperience, order many more tests than seasoned physicians. Many of these tests are ordered indiscriminately.

In a recently published original investigation, greater variability in test ordering was observed with interns than with senior residents or attending physicians. In the following commentary, excessive lab testing was dubbed the Casablanca Strategy, taken from the closing scenes of the movie Casablanca, when the chief of police orders his men to “round up the usual suspects.”  This is not because it will help find the killer (he knows who did it) but merely to gain some time.

In certain ways, this plays out similarly in medicine. Routine and reflexive test ordering allows the clock to tick, provides opportunity for reflection, keeps the patient occupied, allows extra time for diagnostic ideas, and, possibly most important, generates a sense of something being done.

An over reliance on testing is frequently not cost effective and in fact can be potentially harmful. Tests may lead to invasive procedures and these may lead to complications.

So,

Seasoned physicians: don’t overlook opportunities to guide trainees on test ordering

Interns: question why tests are being ordered and how they will guide management

Patients: question all of the above on all aspects of patient care