Watson Jessica, de Salis Isabel, Banks Jonathan, Salisbury Chris
Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West), Bristol, UK.
Fam Pract. 2017 Nov 16;34(6):735-739. doi: 10.1093/fampra/cmx051.
Rates of blood testing are rising with significant geographical variability. Most research into diagnostic testing focuses on the role of tests in diagnostic decision-making.
The aim of this study was to explore the non-medical motives for blood testing by considering what tests do for doctors, through qualitative interviews with general practitioners (GPs).
We undertook 23 in-depth semi-structured interviews with UK GPs. Reasons for performing recent inflammatory marker blood tests were explored by reviewing GPs pathology inboxes to ground discussions in real-life clinical practice. Interviews were transcribed verbatim and analysed using a grounded theory approach.
Blood tests offer doctors a tool to manage uncertainty; within a context of increased litigation, risk aversion and reduced continuity of care. Tests can also be offered as a 'gift' for patients, a way to be seen to be 'doing something'; in the social context of time pressures and perceived patient pressures. There was a tension however. On the one hand, doctors talked about using tests for reassurance and as a 'gift' offering 'truth'. Yet paradoxically, they also discussed the challenges of uncertainty and anxiety from inconclusive test results.
Our study emphasises that defining 'unnecessary' blood testing may not be as simple as determining medical criteria for testing; psychosocial reasons may be equally valid and interlinked. Further research is needed to help GPs manage uncertainty within the context of a risk averse society, and to explore the congruence and dissonance between doctors' and patients' perceptions of testing.
血液检测率不断上升，且存在显著的地域差异。大多数关于诊断检测的研究都集中在检测在诊断决策中的作用。
本研究的目的是通过与全科医生（GP）进行定性访谈，考虑检测对医生的作用，来探索血液检测的非医学动机。
我们对英国的全科医生进行了23次深入的半结构化访谈。通过查看全科医生的病理收件箱，以实际临床实践中的讨论为基础，探讨近期进行炎症标志物血液检测的原因。访谈逐字记录，并采用扎根理论方法进行分析。
在诉讼增加、规避风险和医疗连续性降低的背景下，血液检测为医生提供了一种管理不确定性的工具。检测也可以作为给患者的“礼物”，一种被视为“有所作为”的方式；在时间压力和患者压力的社会背景下。然而，存在一种矛盾。一方面，医生们谈到利用检测来安抚患者，并作为提供“真相”的“礼物”。但矛盾的是，他们也讨论了检测结果不确定带来的不确定性和焦虑挑战。
我们的研究强调，定义“不必要的”血液检测可能不像确定检测的医学标准那么简单；心理社会原因可能同样合理且相互关联。需要进一步研究以帮助全科医生在规避风险的社会背景下管理不确定性，并探索医生和患者对检测的认知之间的一致性和不一致性。
