They are everywhere, these adherents
of an ancient belief that draining people of their blood
will result in a therapeutic benefit. With rare exceptions,
such as hemachromatosis, routine bloodletting should
be discouraged. Then why are so many physicians ordering
so many blood tests? Laboratory tests should be requested
when the results are likely to aid in making a diagnosis
or have therapeutic implications. They should not be
treated like a fishing expedition where one hopes to
get lucky.
Insecure physicians (and those
fearing litigation) will often insist all the blood
tests they order are absolutely essential. That myth
is easily shattered in institutions that require physicians
to perform the venipunctures themselves, resulting in
rapid decreases in blood testing volumes.
Then there are the many physicians
who claim they are so harried that it's easier for them
to have "routine" standing orders so that they do not
have to remember to check the previous results. I have
encountered longterm care patients on a ward who have
had coagulation studies and complete blood counts (CBC)
done daily for almost two months because of standing
orders. As nobody was checking the results there was
nobody to stop the order.
I recall one proud physician who
gloated about her diagnosis of acute infectious mononucleosis
on a 17-year-old with fever, pharyngitis and cervical
adenopathy. When I reviewed the labs I see she ordered
CBC, "mono test," antibodies for hepatitis A, B and
C and hepatitis B surface antigen. In reality only the
CBC and the physical exam would be enough to establish
the diagnosis more than nine times out of 10.
How can the medical profession
improve on the situation? Physicians must be made aware
that blood testing comes with physical and financial
costs which the patients are the first to bear. We need
to do a better job educating our doctors on how to use
our diagnostic tools. We need to eradicate the blood
cult. — Dr Joe Dylewski, Chief of Laboratories,
St Mary's Hospital, Montreal, QC
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