Appropriateness of test use in pathology: a new era or reinventing the wheel?

Pathology has struggled to define and implement changes to improve requesting practices, yet, with the increasing transfer of care from secondary to primary care, our workloads are increasing out of proportion to health care activity. Conversely, some tests appear to be considerably under-used by some general practitioners. Aspects of service reconfiguration such as rationalization of low-volume testing and joint equipment and reagent procurement may release some savings, although any such financial benefits are likely to be quickly nullified by the continued rise in activity and do not contribute to quality of test use. With very large differences between general practices in their use of pathology tests, this review looks at methods for changing pathology requesting activity and calls for involvement from professional organizations to support such initiatives.