Putting the Patient First – Using the Expertise of Laboratory Professionals to Produce Rapid and Accurate Diagnoses

Abstract

The test menu in the clinical laboratory continues to increase dramatically in size, complexity, and cost. There is a growing recognition that errors in test selection and results interpretation can have significant adverse clinical consequences to patients and painful financial consequences to healthcare institutions. Michael Laposata, MD, PhD Since 2008, the Centers for Disease Control (CDC) has sponsored the work of the Clinical Laboratory Improvement in Healthcare Collaborative (CLIHC) to address the patient safety issues associated with incorrect test selection and misinterpretation of test results. A survey by the committee is now in progress of all U.S. medical schools to understand how our newly graduating physicians are learning the appropriate use of the clinical laboratory. Preliminary results from nearly three-quarters of American medical schools indicate some startling facts (personal communication, Brian Smith, MD, PhD). Keep in mind that in practice, physicians are required to order the correct laboratory tests, with thousands of tests from which to choose, largely from what they have learned. On the other hand, however, there are experts in anatomic pathology who systematically interpret every case, and test selection is not an issue because all tests involve the same thing—gross and/or microscopic examination of tissue collected from the patient. Despite this, virtually every medical school teaches more than 100 hours of anatomic pathology, while only 9% have a separate and distinct course in laboratory medicine. Even more startling is that the mean number of hours spent teaching medical students about the appropriate selection of laboratory tests and the correct interpretation of the test results, over the …