On page 3076 in this issue, Wong and colleagues present stunning data to show that by merely changing the hospital laboratory test request form, it was possible to diminish orders for triiodothyronine (radioimmunoassay) and thyroid-stimulating hormone tests by approximately two thirds and one third, respectively. This change followed unsuccessful educational efforts by the authors to guide physicians to use these tests appropriately. Over the same time frame, a control group with creatine kinase and lactic dehydrogenase isoenzyme tests showed no significant difference in ordering frequencies.
The laboratory request slip is analogous to a restaurant menu. Patrons at a restaurant almost always order from the menu. Only the rare customer will order something that is not on the menu. Likewise, physicians order laboratory tests that are on the menu and only rarely order tests that are not so listed. Furthermore, they order tests with the names and in the groupings that