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The Journal of Bone and Joint Surgery 79:1404-14 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

Current Concepts Review

Current Concepts Review - Decision Analysis*

JOSEPH BERNSTEIN, M.S., M.D.{dagger}, PHILADELPHIA, PENNSYLVANIA

*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.


   Introduction
 
Of all practitioners who treat back pain, orthopaedic surgeons are the most expensive9. This distinction has been earned not because of high professional fees but rather because orthopaedic surgeons frequently order expensive, and perhaps unnecessary, diagnostic tests. Unnecessary testing may harm patients and upset payers. It also may provoke insurance companies or governmental agencies to deprive doctors of their autonomy by controlling their ability to order expensive diagnostic tests37. Thus, unnecessary testing may harm physicians as well.

The correct use of diagnostic tests is an important component of effective medical practice65. When tests are used at the wrong time or are interpreted inappropriately, not only are resources wasted on the test itself but also an incorrect course of clinical action might be taken. The ordering of tests only when they are appropriate is a skill that may be attributed to the art of medicine. Nevertheless, basic principles . . . [Full Text of this Article]


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