Opinion: Stopping doctors from ordering unnecessary diagnostic tests requires a structural fix
Get the Health newsletter
Daily health & science — research, biotech, public health, the studies worth knowing. Free.
- American medicine runs more than 14 billion diagnostic tests a year, many used on the wrong patients at the wrong time and resulting in useless or harmful outcomes, per the op-ed.
- Urine cultures rank among medicine's most overused tests: asymptomatic patients frequently receive unnecessary antibiotics after positive cultures, fueling antibiotic resistance.
- A Michigan project across 46 hospitals tried physician education first but saw no impact on reducing unnecessary antibiotic treatment for asymptomatic bacteriuria.
- Diagnostic stewardship — requiring doctors to enter true UTI symptoms to order a urine culture, or having labs only process samples showing inflammation — cut unnecessary treatment from roughly 29% to under 17%.
- The approach works because interventions happen centrally in electronic medical records and lab processing, so a single change can reshape care for hundreds of thousands of patients, drawing on behavioral economics to change default ordering paths while preserving override options.
- Unnecessary CT scans can flag benign lesions that trigger surgical biopsies with complications like bleeding and infection, and misleading DNA tests can flag harmless viral fragments and delay necessary surgery, the op-ed notes.
- Microsoft researchers have shown AI systems inherit human over-testing patterns from training data and need diagnostic stewardship principles embedded at the design stage, not added later.
Why it matters: Structural changes to test ordering cut inappropriate antibiotic use from 29% to under 17% across 46 Michigan hospitals without new drugs, pointing to 14 billion annual U.S. tests as a major cost and harm-reduction target. The CDC has called for stewardship programs but lacks a confirmed director to enforce them.
