• Norbert Donner-Banzhoff.
• Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps-Universität Marburg. Norbert@staff.uni-marburg.de
• Z Evid Fortbild Qual Gesundhwes. 2011 Jan 1; 105 (7): 519-24.

AbstractMany diagnostic tests ordered by physicians cannot be justified by rational criteria. However, this is not necessarily a problem of knowledge or lack thereof. The rational use of diagnostic tests must also be understood as a behavioural problem. Apart from knowledge, financial incentives, tradition and patient expectations have an impact on diagnostic decisions, too. Traditional academic teaching with its emphasis on pathophysiology prevents medical students from adopting a critical attitude to diagnostic testing. Against the background of cognitive psychology research on adaptive behaviour, I would suggest to increase clinical exposure in the undergraduate curriculum. This should be accompanied by a "reflective practicum" to improve the understanding of the usefulness of diagnostic tests in a particular situation. Working environments should be examined as to the feedback they provide for clinicians. Remuneration and utilization patterns may be more important determinants of test-ordering than a clinicians' knowledge. Nevertheless, a basic understanding of Bayes' theorem and likelihood ratios are an essential part of the medical curriculum.Copyright © 2011. Published by Elsevier GmbH.

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