When ordering tests, it is important to always consider the diagnostic characteristics such as sensitivity, specificity and predictive value in light of the patient’s pre-test probability. Patients who are at very low baseline risk often do not require an additional test to rule out the diagnosis. Furthermore, evidence suggests that in such low-risk patients, diagnostic tests do not reassure patients, decrease their anxiety, or resolve their symptoms. Examples include the use of computed tomography (CT) scanning in low-risk patients to rule out pulmonary embolism, or pre-operative cardiac testing for patients prior to low risk surgery. Evaluation of baseline risk and the use of decision tools wherever possible, along with a ‘how will this change my management’ approach, can help to avoid unnecessary ‘rule out’ testing in patients.
Sources:
Choosing Wisely Canada. Canadian Association of General Surgeons: Six things physicians and patients should question [Internet]. 2014 [cited 2017 Jun 5].
Choosing Wisely Canada. Canadian Association of Nuclear Medicine: Five things physicians and patients should question [Internet]. 2015 [cited 2017 Jun 5].
Choosing Wisely Canada. Canadian Cardiovascular Society: five things physicians and patients should question [Internet]. 2014 [cited 2017 Jun 5].
Choosing Wisely Canada. Canadian Society of Internal Medicine: Five things physicians and patients should question [Internet]. 2014 [cited 2017 Jun 5].
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