By Frances Chamberlain
The process of taking blood in a clinical setting is simple, and relatively low cost. This tends to be accepted by most patients as well. But British researchers are questioning whether the practice of routine blood work is really justified or worthwhile.
A new report in the British Medical Journal (BMJ) poses this question: “Should we abandon routine blood tests?”
The article’s lead author — Alastair Faulkner, an orthopedic trainee at Ninewells Hospital, Dundee, England — notes “requesting a standard battery of blood tests without due regard to clinical indication has become the norm.” He goes on to say that the practice of “routine bloods” is “damaging for clinicians, finance managers, and patients.”
The problem, he explains, is that ordering blood work has become routine, often without considering the patient’s specific complaints. The United States, he adds, has a high level of expenditures compared to other developed countries, and the use of blood tests is “ubiquitous and excessive.”
Blood tests aren’t the only culprit in our healthcare system. Anecdotal evidence shows that imaging tests, CT scans, MRIs and x-rays are also often overused. A patient with a minor headache may get a CT scans, which is more harmful than beneficial, Faulkner explained.
The tendency to order the “full house” of blood work — including blood count,, urea and electrolytes, liver function tests and C reactive protein — may be a “psychological comfort blanket” for clinicians, but does little to boost the health of most patients, he claims.
The tendency to order blood work as a routine rather than when it is indicated by the patient’s condition results in risk to the patient and expenses that are unwarranted. Venepuncture, the act of taking blood, is most risky for frail, elderly patients whose veins or skin may be vulnerable.
For the majority of patients it is important to consider the risk of infection, if blood thinners may cause risk of bleeding, bruising, hematoma formation (a collection of blood underneath the skin that can become infected), as well as skin trauma. The worst case scenario is sepsis, where the introduction of bacteria may enter the blood stream causing systemic infection.
So, what’s a patient to do? Faulkner suggests the following:
Ask to be informed about the reason for any tests your doctor orders, including something so common as blood work. If you aren’t given a good reason, opt out them.
Ask your doctor to lay out the risks and benefits of blood testing procedures.
Remember that you have the right to be informed about your care. A blood test “just because we can” may not be in your best interests
The rationale for questioning routine blood tests comes partly an initiative known as Choosing Wisely, which is designed to reduce the number of costly and unnecessary medical procedures that don’t have a clear benefit to patients.
“There should be nothing ‘routine’ about decision making that can impact both patient care and … finances,” says Faulkner. “As clinicians, we have a duty to lead culture change as effective stewards of clinical resources…”
He suggests that clinicians should change the way they think about routine blood work, asking not just “can this test give me more information?” but rather “will the result of this test change the management of my patient?”