An Historical Perspective on the Clinical Diagnostic Laboratory

Abstract

As the clinical diagnostic laboratory has entered the 21st century, it is interesting to reflect on past scientific and social events that have influenced the status of the laboratory and to anticipate future problems and opportunities. It would be a mistake to suggest that all of the significant medical and social events that had an impact on the present laboratory function can be discussed or evaluated in a short introductory chapter. It is also possible to mistakenly attribute more influence to some events than they deserve simply because they are being interpreted with a 21st century bias. However, some threads of commonality have influenced the evolution of diagnostic laboratories from earliest times. It is the objective of this chapter to highlight events that, in my opinion, have shaped how and/or why clinical laboratories have arrived at their present position in the practice of medicine. A history of diagnostic testing can be started by reviewing the evolution of diagnostic tests from isolated procedures to organized diagnostic laboratory testing. Originally, laboratory tests were performed at the side of the patient with small, simple equipment, rapid evaluation of the result, and a diagnostic opinion rendered. Test choice, performance, and interpretation were all left to the individual practitioner. There was no professional support staff to assist at any point in the process. Little exchange took place between practitioners because the individual’s success was directly related to which procedures were done and the manner in which they were done. A premium was paid for showmanship as well as successful treatments.