What makes general practitioners order blood tests for patients with unexplained complaints? A cross-sectional study

Eur J Gen Pract. 2009;15(1):22-8. doi: 10.1080/13814780902855762.


Background: Approximately 13% of consultations in general practice involve patients with unexplained complaints (UCs). These consultations often end with general practitioners (GPs) ordering blood tests of questionable diagnostic informativeness.

Objective: We studied factors potentially associated with GPs' decisions to order blood tests.

Methods: Cross-sectional study. Twenty-seven GPs completed registration forms after each consultation concerning newly presented UCs.

Results: Of the 100 analysable patients, 59 had at least one blood test ordered. The median number of ordered tests was 10 (interpercentile range [IPR-90] 2-15). Compared to abdominal complaints, the blood test ordering (BTO) probability for fatigue was five times higher (relative risk [RR] 5.2). Duration of complaints for over 4 weeks also increased this probability (RR 1.6). Factors associated with a lower BTO probability were: likelihood of background psychosocial factors (RR 0.4) and GPs having a syndrome rather than symptom type of working hypothesis (RR 0.5).

Conclusion: We found a high rate of BTO among GPs confronted with patients with UCs. Furthermore, a considerable number of tests were ordered. The selectivity in BTO behaviour of GPs can be improved upon.

MeSH terms

  • Abdominal Pain / diagnosis
  • Abdominal Pain / etiology
  • Adult
  • Cross-Sectional Studies
  • Family Practice / methods*
  • Family Practice / standards
  • Fatigue / diagnosis
  • Fatigue / etiology
  • Female
  • Hematologic Tests / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Physicians, Family / standards
  • Physicians, Family / statistics & numerical data
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Unnecessary Procedures / statistics & numerical data