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In reply to 'clinical biochemistry test eliminator providing cost-effectiveness with five algorithms': the Casablanca
Albrecht Betrains1, Steven Vanderschueren1
1Department of General Internal Medicine, University Hospitals Leuven, Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Infectious and Inflammatory Disease, Leuven, Belgium, albrecht.betrains@kuleuven.be.
Abstract:
In this journal, Ataman Gönel recently demonstrated that elimination of requested unnecessary tests by means of algorithms in an artificial intelligence program may contribute to the cost-effectiveness of medicine. However, test ordering is an essential part of clinical medicine and decision-making. Interns are responsible for a modest but significant excess in laboratory utilization and underestimate their control over laboratory testing. Even in the hands of experts, rational approaches to test ordering may be subverted by the Casablanca Strategy. Establishing a differential diagnosis and ordering only tests deemed necessary reflect the attainment of expertise in the clinical decision-making process. Residents and attendings in teaching roles should not underestimate the extent to which their clinical decision-making may be mimicked.
