Understanding laboratory testing in diagnostic uncertainty: a qualitative study in general practice

Background: Better knowledge of the professional: motives or ordering laboratory tests in the case of diagnostic uncertainty may lead to interventions directed at reducing unnecessary testing. Aim: To gain insight into the general practitioner:5 (GPs) motives,for ordering laboratory tests or patients presenting with unexplained complaints Design of study. Semi-structured interviews based on surgery observations. Setting. Twenty-one general practices in rural and urban areas of The Netherlands. method. Investigation of the GP perception of determinants of test-ordering behaviour in the situation of diagnostic uncertainty. The interviews were structured by evaluating the consultations that day. and test-ordering performance of Results. Dutch GPs vary considerably in their motives for ordering tests. Numerous motives emerged from the data. Some examples of important themes include., personal routines; tolerance of of diagnostic uncertainty; time pressure, and tactical motives or,f the patient test ordering. complying with the perceived needs of for reassurance through testing is seen as an easy, cost- and time-effective strategy. A clear hierarchy in the determinants was not,found. Conclusion: The decision to request laboratory testing is the result of a complex interaction of considerations that are often conflicting Designers of interventions meant to improve the con ordering of tests should be aware of the numerous determinants, and take contextual variables into account.