To the Editor: In their editorial,1 Hammett and Harris have overlooked one of the most important contributory factors to the increased use of diagnostic tests by community-based practitioners (ie, GPs) — patient demand.

It is not unusual for a GP to be faced with a request by a patient to be "tested for everything", or for a specific test that may be quite inappropriate ("I just want my hormones checked").

It takes far longer to explain to the patient that the tests are inappropriate than to give in and sign the appropriate pathology form. And then, if the patient a year later does come down with some obscure syndrome, he or she can come back in the courts and say, "If only the doctor had listened to my request for tests I would be okay now".

The frontline GP is in a lose–lose situation, stuck between the Health Insurance Commission and its demands for reasonable levels of testing, the expectations of patients that everything can be detected by a blood test, and the excessively perfectionist ideals of the legal system.