It is often necessary to arrange for special tests to assist in the diagnostic process or to monitor the progress of certain illnesses or response to treatment. The informed consent of patients must be obtained. A collaborative decision for or against certain tests may be negotiated. General practitioners have a responsibility (clinical and economic) to be very discerning and selective in the investigations that they choose. The questions that should be asked in decision making include:

• 'Is this investigation necessary?'

Richard Asher (1954) listed the questions a clinician should ask before requesting an investigation: 6

• 'How will this affect my management of the case?'

• 'Will this ultimately benefit the patient?'

In general, investigations should be performed only when the following criteria are satisfied. 1

• The consequence of the result of the investigation could not be obtained by a cheaper, less intrusive method, e.g. taking a better history or using time.

• The risks of the investigation should relate to the value of the information likely to be gained.

• The result will directly assist in the diagnosis or have an effect on subsequent management.

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