Laboratory medicine: a view to the future of diagnostics and training

Laboratory Medicine is poised to undergo quantal changes over the next decade. These are pregnant with opportunities to impact medical care in new ways as well as being fraught with dangers to our management of diagnostic modalities. New knowledge brought about by the human genome and functional genomics endeavors have led to new biomarkers, many of which are prognostic or theragnostic rather than simply diagnostic, thus introducing new testing modalities, such as deep sequencing and proteomics. Computer algorithms can derive associations and implications based on changes in a multitude of 'weak' biomarkers, necessitating the assessment of large panels of targets rather than discrete biomarkers. The linkage of genomics and proteomics to morphometric aspects blurs the lines between Laboratory Medicine and Anatomic/Surgical Pathology or Radiologic imaging. The utility of these diagnostics is being push closer to the patient to speed implementation as cost issues drive the need for rapid decision making. Despite the resource pressures on all of medical care, laboratory diagnostics remain the most cost-efficient aspect and thus will be even more in demand as practice is shifted towards rapid laboratory medicine. These great opportunities for a new golden age in Laboratory Medicine will depend to a great extent on our ability to train the next generation not only in these new technologies and knowledge bases but also in this new mode of information delivery and direct interactions with patient-care physicians and patients themselves.