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Comment & Response
May 2019

Analyze Patient Tests for Importance Before Ordering

Author Affiliations
  • 1Saint Louis University, St Louis, Missouri
  • 2Internal Medicine Residency Program, Saint Louis University, St Louis, Missouri
  • 3Ambulatory General Internal Medicine, Saint Louis University, St Louis, Missouri
JAMA Intern Med. 2019;179(5):729-730. doi:10.1001/jamainternmed.2018.8369

To the Editor We read with interest the Research Letter by Geleris and colleagues1 discussing the laboratory and radiographic ordering habits of their internal medicine residents. Current literature suggests a correlation between where a physician trains and how they practice medicine. For example, location of residency training is correlated with how American Board of Internal Medicine examinees answer high-value care questions.2 Geographic location of training also correlates to variable costs of care of practicing internists based on Medicare claims data.3 We, therefore, would expect ordering habits to be relatively homogenous within a single residency program; however, the residents studied by Geleris and colleagues demonstrate widely variable ordering practices. This variation within a single residency program suggests that factors beyond training location influence resident practice patterns.

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