Laboratory use: attitudes implicit in a national examination.

The quantitative principles of test selection and interpretation have been reluctantly integrated into clinical practice. This reluctance may reflect an underlying faculty attitude towards the laboratory. To evaluate this attitude, the scoring standards used for 23 patient management problems (PMPs) in the 1980 and 1983 Medical Knowledge Self-Assessment Programs were reviewed. All diagnostic options were categorized by dollar cost, risk, and a determination of "routineness." Attitudes were probed by reviewing the scores obtained by indiscriminate selection of all items in a category. Our analysis indicated that the examiners valued routine, little-ticket, little-risk items. Such selection would be rewarded 85% of the time and in 95%, no penalty would be received. Further, indifference was more frequent for little-ticket items and accounted for 11.7% of acceptable diagnostic expense. An examinee analyzing these scoring keys could reasonably conclude that routine, little-ticket items should be ordered whenever offered. Hence, at a national level, there is an attitude that implicitly encourages the use of these items in clinical practice.