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April 12, 1995

Routine Laboratory Tests in Impaired Nursing Home Residents-Reply

Author Affiliations

Edith Nourse Rogers Memorial Veterans Hospital Bedford, Mass

JAMA. 1995;273(14):1092. doi:10.1001/jama.1995.03520380028030

In Reply.  —We thank Dr Richardson for his comments and second his caution regarding our study's implications. We also emphasize that our results do not support the casual notion that all assessments of the nursing home patient are useless. Management of complex elderly patients requires a high level of critical thinking and decision making, particularly concerning conventional tests used in the traditional medical model. Our study addressed only one of these traditional assessment tools, namely, the comprehensive laboratory test battery. We do not quite agree that these tests have been "debunked." Rather, we believe our results enable clinicians to customize and fine-tune the use of these tests to individual patients.Our overriding intention was to discourage automatic, unthinking laboratory testing and to encourage the more thoughtful approach of explicitly identifying one's purpose in ordering tests. As confirmed by our study, the value of testing varies among screening, monitoring, follow-up, and

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