Part of my question was triggered by several articles by Christine Sinsky MD from the Institute of Medicine relating to maximizing efficiency and pleasure in practice and published in the Annals and elsewhere. She strongly encourages the "lab ahead" method. However, she also encourages the use of an RN rather than a medical assistant to handle a lot of basic decision making, and has had the good fortune to have hired some talented help that could do things like figure out the needed labs autonomously. Although our MA's are good, that sort of decision making is largely beyond them and our talent pool is not that big (nor our budget). That task does seem like something just begging to be delegated.
