Infectious Disease · Internal Medicine ·
Commentary Urges More Deliberate Testing Within Clinical Order Sets
A perspective in the *Journal of General Internal Medicine* argues that standardized order sets can prompt testing without adequate consideration of clinical context. Two infectious-disease referral examples illustrate how positive results may lead to unnecessary consultations and patient concern; the article calls for order sets that support, rather than replace, diagnostic reasoning.
- Order sets may encourage testing without clinical-context review.
- Prior TB can complicate interpretation of a positive IGRA.
- Galactomannan testing is most useful in immunocompromised patients.
- The article presents a perspective, not new outcome data.
Standardized order sets can improve consistency, safety and efficiency, but they may also encourage clinicians to order tests reflexively, argues this perspective in the *Journal of General Internal Medicine*. The author describes two infectious-disease referrals: a positive tuberculosis interferon-gamma release assay in a patient previously treated for active TB, and a positive serum Aspergillus galactomannan test in a patient without immunocompromise whose clinical picture had low suspicion for invasive aspergillosis. Both tests had been included in order sets, and the results prompted referrals.
The article notes that IGRAs do not distinguish past from present infection and are of limited use in people with prior TB. Galactomannan testing is most useful in immunocompromised patients; outside these populations, test performance is poorer and positive results may be false positive or clinically irrelevant. The author argues that such testing can lead to additional investigations, unnecessary referrals, patient anxiety and costs, and delays in access to specialist care.
The piece acknowledges established benefits of order sets, including improved standardization and outcomes in some care settings. It is a perspective, not a comparative study, and presents clinical examples rather than new outcome data. Its central argument is that order sets should encourage clinicians to consider the clinical question and pre-test probability before ordering tests, with thoughtful design and ongoing oversight.
In practice
For clinicians using standardized order sets, the article highlights the importance of checking whether a test fits the patient's history and pre-test probability before ordering or acting on a positive result. This is particularly relevant to TB IGRA testing after prior TB and galactomannan testing in patients without immunocompromise. The piece is a perspective illustrated by two cases, not a trial or evaluation of an intervention, and does not establish that changing order sets improves patient outcomes.
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Journal of General Internal Medicine: Thinking Before Clicking: Reclaiming the Art of Diagnostic Humility ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.