Reflective testing--what do our service users think?

BACKGROUND: Reflective testing incorporates the clinical judgement, knowledge and experience of an individual biochemist to request additional tests appropriate to the clinical scenario. Despite being vigorously debated within the biochemistry profession, little is known about how the clinicians directly involved in patient care feel about it. We have conducted a survey to elicit our service users' opinion of reflective testing. METHODS: Ten clinical scenarios, each involving the possible addition of a specific test, were circulated to 520 hospital doctors and 152 general practitioners. The four response options were to add further tests, phone and discuss the case, add a comment to the original results or do nothing. RESULTS: A total of 216 (32%) responses were received. Overall, the majority were in favour of 'adding on' free triiodothyronine (86%), gamma-glutamyltransferase (78%), lipid profile (59%), thyroid peroxidase antibodies (63%), pituitary hormones (58%), troponin (55%) and serum electrophoresis (68%) in the given scenarios. However, only 30% would like a pregnancy test added and only 45% a prostate-specific antigen added without prior consultation. The response differed according to grade and specialty. CONCLUSIONS: Reflective testing is generally welcomed by our service users, provided the nature and implications of the specific test is considered in addition to the full clinical scenario.

Reflective testing: what do patients think?

INTRODUCTION: Reflective testing refers to the practice of adding on tests by laboratory staff. Little is known about what patients think of this practice. METHODS: We surveyed patients attending a general practice surgery and patients attending hospital outpatient clinics. We sought their views about the practice of adding on tests and about the information they received from requesting clinicians about their investigations. RESULTS: In both groups of patients, large majorities favoured an approach in which relevant additional tests are performed without consulting the requesting clinician or patient first. Most patients also felt that the requesting clinicians had provided a satisfactory explanation about what tests were to be performed and why. CONCLUSION: Most patients are content to let NHS professionals add on relevant tests if this is felt to be in their interest.

[Laboratory input. General practitioners positive about reflective testing]. / Eigen inbreng van het laboratorium. Huisartsen positief over 'reflecterend testen'.

OBJECTIVE: To investigate the opinion of general practitioners on reflective testing, i.e. the practice of additional tests being performed and comments added to the results by laboratory staff when appropriate. DESIGN: Descriptive. METHOD: In the eastern South Limburg region 155 general practitioners received a list of 10 fictitious patient cases, each involving the possible addition of a specific test. The general practitioners could choose what they preferred the laboratory to do: add tests, phone the general practitioner, add a written comment or do nothing. In addition the general practitioners were asked to judge the effect of additional tests and comments on patient management with respect to diagnosis, treatment and referral, using 200 laboratory reports from their own patients. RESULTS: The response to the fictitious cases was 45%. Most general practitioners favoured the laboratory taking the initiative by adding on tests and commenting on the results in the given clinical scenarios. 78% of the questionnaires accompanying the lab reports were returned by 87% of the general practitioners. In nearly all cases (99%) the service was marked as useful. In more than half of the cases (53%) reflective testing affected the measures taken by the general practitioners. CONCLUSION: Reflective testing was in general welcomed by the general practitioners. In the majority of cases this led to an improvement in the diagnosis or adjustment of treatment.