“Rational pathology emanates from a rational doctor”.  Pathology is useful in assisting with coming to a diagnosis, monitoring patients and for screening.  Unnecessary tests can cause harm to patients and add significantly to health costs, so considering carefully what pathology we order is vitally important in General Practice.

In this month’s post, we listen in on the discussion with Dr Mike Eaton during a webinar with some of the second year GP registrars.

Dr Eaton is one of the Medical Educators with RVTS and is an experienced GP based in WA.  Mike’s webinar on Rational Pathology covered many topics that we see in general practice.  For registrars mastering the art of General Practice, it’s important to consider that investigations should always be indicated and appropriate, while considering the guidelines and recommendations, maintaining a patient-centred approach and fostering a tolerance of uncertainty.  It’s quite a balancing act – one worth discussing with your supervisor. 

Dr Eaton highlights that the enemy of rational pathology is irrational pathology: requesting tests that are not indicated, not necessary, non-contributory or non-sensical.  This occurs for various reasons, the first being that tests are ordered before thinking through the problem. We are cautioned against doing “routine testing” without considering why each test is being requested individually, and asking ourselves if a patient really needs the test.

Listen to excerpts from the webinar below: (20min 30 sec)

In the recording we mention the website “Choosing Wisely”, who have gone NUTS (which stands for “No Unnecessary Tests).  You can review their recommendation on pathology tests discussed in the excerpt, as well as other recommendations using the link in the references below.

Registrars are encouraged to reflect on their pathology requesting behaviour and discuss this topic with their supervisor to review if their pathology requests are rational, or if they indicate a gap in knowledge, understanding, or reveal a belief that being “thorough” requires extensive testing.  This may unveil a deeper cultural perspective around patient care, addressing fears about missing something crucial or being sued.

We should all aspire to request pathology rationally with good supportive evidence and a healthy tolerance of uncertainty.

References: 

  1. Home – Choosing wisely
  2. RACGP AFP (AJGP): We live in testing times – teaching rational test ordering in general practice
  3. GPSA: Rational test ordering in general practice
  4. NPS MedicineWise: Dealing with uncertainty: A diagnostic approach to fatigue