Take the following hypothetical list of laboratory tests:

• FBC
• U&Es
• LFTs
• Thyroid Function tests
• Hepatitis A, B & C screen
• HIV
• Treponemal screen
• ANA
• Coagulation screen
• Complement
• Autoantibody screen
• EBV serology
• CMV serology
• Urine culture
• MRSA screen
• Serum lipids

In laboratories across the world, this kind of “shopping list” request form coming into the laboratory is seen all too frequently, and often without any clinical justification or rationale included.

Add up the costs of these tests and you have a total of several hundred dollars, maybe even over a thousand. A CT scan would be roughly an equivalent cost, and you would be hard pushed to get one of those without justifying exactly why you wanted it….

There may of course be a very valid reason for ordering all the tests above, although it is difficult to think of a clinical syndrome which would justify everything in the list above.

Such a list may be done as a “wellness screen”, but whether you believe in wellness screening or not, there are tests in here (EBV, CMV, urine culture for starters) which should never be part of any wellness screen laboratory testing.

Such a list may be done as a “fishing expedition” when the patient presents to the clinician with vague or ill defined symptoms. The problem is that the prevalence rates for most of these tests in such patient populations are going to be very low with the consequent problems of low positive predictive value and false positive results.

Personally I don’t believe that shopping list requests such as the above that are sent into the lab by clinicians should be permitted unless there is a clear rationale on the request form detailing why so many tests have been requested in the first place…..

Courtesy, respect, and common sense.

Michael

Of course if your laboratory is on a fee for service funding arrangement you might welcome “shopping lists” or at least turn a blind eye to them…. Personally however I have never been a great fan of shopping!