Laboratory-clinician interaction and the interpretation of test results

Medical care has become more complex and dependent on technological innovations such as computerised tomography and laser surgery. The use of computers for diagnostic purposes and the emergency of the field of artificial intelligence as purveyor of the medical data base, have given the practitioners a very large body of data to which they must apply their considerable ability. However, the more methods become sophisticated and technically advanced, the greater the need for close cooperation and sharing of expertise between the various components of the delivery of health services. In this context, the clinical laboratory is an amplification of the physician's senses so that he can 'see', 'hear' and 'feel' at cellular, molecular and atomic levels. This is carried out by optimised use of laboratory capabilities by the clinical biochemist and the physician. The bedside is the meeting point between the clinician and his consultants and the patient. It is here that a decision will be made that will have a profound effect on the health of the patient. The ability of the clinical biochemist to design test strategies, control sample handling and interpret laboratory data, is greatly enhanced by having him at the bedside, in close cooperation with the physician. This relationship between the patient, the physician and the laboratory is seen in Figure 6.2. The physician, even with the most sophisticated and modern bedside instruments, cannot be expected to be an expert in properly evaluating test results. He is an expert in synthesising a large body of expert evidence into diagnosis and treatment of his patient. Refusing to consult the clinical biochemist on the interpretation of laboratory data or receiving non-expert consultation can have serious consequences to the patient. However, the clinical biochemist can only truly provide expert analysis if he is 'near' the patient and can be attuned to his physical as well as his emotional and social state which have a great influence on the interpretation of his physiological status. This latter aspect was extremely well put by Peabody almost 60 years ago and is still correct today. Clinical biochemistry must be 'near' the patient to fully realise its professional status.