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May 26, 1978

Routine Admission Testing

Author Affiliations

University of Cincinnati Medical Center Cincinnati

JAMA. 1978;239(21):2239-2240. doi:10.1001/jama.1978.03280480031006

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To the Editor.—  I have great respect for the professional skills of G. William Cole, MD, but his response to the question about hospital costs and number of tests ordered (238:2644, 1977) is incomplete and, I believe, misleading.Instrumentation in his hospital made it possible to increase the number of admission tests by 312% without increasing the direct cost. Unless Dr Cole is using some radically new method of manipulating the data derived, he also has increased the number of false-positive results by 312%. I know of no studies of chemistry screens and the like that have claimed any sort of corresponding increase in quality of care or in numbers of cases detected of truly latent, unsuspected, significant but treatable disease.Dr Cole's approach, I am afraid, must lead to many more cases of "artefactual illness" that have to be evaluated and excluded (expensive and time-consuming) or ignored (bad medicine