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Costs—Adding Up the Little Things

William E. Golden, MD
JAMA. 1980;243(19):1932. doi:10.1001/jama.1980.03300450046025.
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Recent articles in the medical literature voice concern over the rising costs associated with increased use of routine laboratory tests. The prevalence of automated screening of sera for biochemical and immunologic abnormalities has fostered a casual attitude toward obtaining additional information about a patient's biological profile. In addition, the creation of a new class of allied health personnel (ie, laboratory liaison technicians, phlebotomists—"the stickers") has removed another barrier to the use of laboratory facilities. Using a disinterested person to obtain blood from a patient frees the attending or house staff physician from the time commitment and potentially uncomfortable personal interaction connected with collecting yet another sample of body fluid. In many hospitals ordering a test has become merely the translation of thought to paper—the technicians, the laboratories, and the billing office take care of the rest of the logistics.

It is not surprising, then, that laboratory use often reflects physician


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