Telling the right patient.

The survey showed that senior registrars and consultants were considerably more efficient than their junior staff in instigating effective investigations, although they may have seen a different type of patient, and the number of emergency requests was not altered by the survey itself, nor by a poster demonstration of its results.

Abstract

for the immediate management of the patient, there is con- siderable room for a reduction in cost with no loss of effective- ness.Payments of over £20 000 were made for emergency biochemistry calls in this hospital in 1978-9.Although there is little published information, comparison with Scottish laboratories of similar size shows that we do not have a uniquely large out-of-hours work load in relation to total work load.3Perhaps these costs are not excessive: they amount to about £3 an hour for emergency cover outside normal laboratory hours for 365 days a year (including weekends and holidays), cost under 2 5%, of the total drug bill, and are of the same order as the annual expenditure in this hospital on cimetidine.Nevertheless, they can clearly be reduced with no loss of effectiveness.How may this be achieved?The number of emergency requests was not altered by the survey itself, nor by a poster demonstration of its results.Our survey showed that senior registrars and consultants were considerably more efficient than their junior staff in instigating effective investigations, although they may have seen a different type of patient.It has been suggested that greater teaching emphasis should be placed on the "patient care-laboratory interface" when training house staff.4There is impressive evidence from Harvard Medical School that a reduction of nearly one-half in all biochemical and serological tests requested by junior clinical staff was achieved by four one-hour sessions early in their internships, during which juniors discussed the case notes of their patients with their seniors; this reduction in requests for tests was sustained.5Previous studies have shown similar results.6We believe that this approach to postgraduate medical education will prove the most appropriate way to increase the effectiveness and efficiency of clinical investigation.Consultants in the clinical specialties should consider the evidence that they and those responsible to them are using the available resources inefficiently, and that a short period spent with newly appointed house staff on reviewing case notes will be both practically and intellectually rewarding.