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"Don't you want to check my urine?" As a practitioner with training in costeffective care, I find it difficult to justify the expense of a urinalysis for the "in to get a Pap smear and birth control" set who make up much of my managed care clinic, especially when a blood glucose test has already been ordered. For patients without urinary complaints or risk for malignancy, there really is little reason to do so. So why do patients, school bus driver physicals, and college entrance exam forms all demand such arcana as the urine specific gravity?
Joel Howell's fascinating look at the introduction of medical technology into the hospital between 1900 and 1925 elucidates the process by which certain tests became "routine," even when there was little evident usefulness for them. After a meticulous analysis of hospital records drawn from two institutions (in New York City and Philadelphia),
Humphreys M. Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century. JAMA. 1996;276(5):424. doi:10.1001/jama.1996.03540050084033