Diagnostic tests

Prevalence of detecting a serious condition may be as low as 0.5-3% when tests are ordered in patients with low probability of disease (Rolfe A, Burton, C).

Associated with increased healthcare costs.

Associated with wide geographic variation in the use of testing.

Diagnostic tests with a 90% sensitivity and a 90% specificity, yield 4-19 false-positive results for every true positive result in patients for whom such a test was ordered to rule out a disease for which clinical suspicion was low.

False positive testing results in additional testing, sometimes invasive procedure, and patient anxiety.

False negative results are also a significant concern.

Clinical history taking typically accounts for 75% or more of the diagnostic yield when evaluating symptoms, and the physical exam 10 to 15%, while diagnostic testing generally less than 10% (Kroenke K ).

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