Testing for Uncommon Conditions

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Abstract
The improper ordering of clinical laboratory tests by physicians has generated growing concern in recent years. An estimated 5 billion tests are ordered each year in the United States, and available resources to support such widespread testing are increasingly limited.1 The growing evidence of significant geographic variations in the use of certain tests2— and that much of this testing may be unnecessary3—has stimulated national interest in the development of practice guidelines and other measures to modify physician practice behavior.4 Much of the current concern about the magnitude of laboratory testing that has stimulated these activities has focused on its potential impact on the health care system as a whole, and the principal argument has been economic.5 Insufficient attention, however, has been given to the clinical effects of testing on the patient, perhaps because there is a tendency to believe that such effects either