November 17, 1978

How Physicians Use Laboratory Tests

Author Affiliations

Erasmus University Rotterdam, The Netherlands

JAMA. 1978;240(21):2246. doi:10.1001/jama.1978.03290210028007

To the Editor.—  Having conducted a study1 similar to the one Laurence P. Skendzel, MD, describes in "How Physicians Use Laboratory Tests" (239:1077, 1978), I can underline his finding that physicians react widely different to laboratory test results. This diversity in attitude has been described before2-4 (201:519, 1967). West,3 for example, concludes: "Under certain common circumstances some diabetologists would classify as normal more than half of the one- and two-hour (glucose) values considered to be abnormal by other well-qualified diabetologists."My comment on Dr Skendzel's article relates to the experimental setup of his study. He presented a series of brief clinical problems to specialists in internal medicine. In each case an initial laboratory result for a certain constituent was given. Clinicians were asked to indicate which subsequent value in the same patient would be compatible with a medically important change. The initial values were all purposely selected