What makes general practitioners order blood tests for patients with unexplained complaints? A cross-sectional study.
BACKGROUND
Approximately 13% of consultations in general practice involve patients with unexplained complaints (UCs). These consultations often end with general practitioners (GPs) ordering blood tests of questionable diagnostic informativeness.


OBJECTIVE
We studied factors potentially associated with GPs' decisions to order blood tests.


METHODS
Cross-sectional study. Twenty-seven GPs completed registration forms after each consultation concerning newly presented UCs.


RESULTS
Of the 100 analysable patients, 59 had at least one blood test ordered. The median number of ordered tests was 10 (interpercentile range [IPR-90] 2-15). Compared to abdominal complaints, the blood test ordering (BTO) probability for fatigue was five times higher (relative risk [RR] 5.2). Duration of complaints for over 4 weeks also increased this probability (RR 1.6). Factors associated with a lower BTO probability were: likelihood of background psychosocial factors (RR 0.4) and GPs having a syndrome rather than symptom type of working hypothesis (RR 0.5).


CONCLUSIONS
We found a high rate of BTO among GPs confronted with patients with UCs. Furthermore, a considerable number of tests were ordered. The selectivity in BTO behaviour of GPs can be improved upon.
Division of Clinical Methods and Public Health, Department of General Practice, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. h.koch@amc.uva.nl
Hèlen
H
Koch
Marloes A
MA
van Bokhoven
Gerben
G
ter Riet
Kirsten M
KM
Hessels
Trudy
T
van der Weijden
Geert-Jan
GJ
Dinant
Patrick J E
PJ
Bindels
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000328:Adult; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000379:methods* / Q000592:standards; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006403:Hematologic Tests / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010821:Physicians, Family / Q000592:standards / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data