Dear colleagues
this is an interesting thread, which illustrates a wider problem: that of a
lab refusing to carry out tests which have been requested by a clinician
which the lab believes may be unhelpful or misleading.
The ethics of a lab adding on tests not initially requested which it
believes may help clarify the clinical picture are not entirely
straightforward, and have been previously debated in this arena (and were
the basis of a short publication some 10 years ago) - however, most users of
our service entirely support the notion that a lab should add on tests which
are felt appropriate in the given clinical scenraio.
Based on small surveys, most of our users do not agree that a lab should
delete requested tests because the lab may feel that the requested tests are
inappropriate or may lead to misleading evidence. But every day, most of us
come across many examples of such requested tests, and I for one feel we
have a clear professional duty to educate our users and to reduce as far as
possible the requesting of potentially inappropriate or misleading tests
which are a waste of resources and may lead to totally un-necessary concern
and inappropriate further investigation and treatment for patients. This is
part of our professional responsibility; and if it comes to a legal case we
have to be prepared to defend our professional decisions in a legislative
and public arena which may well know nothing or be totally misinformed about
the problems. But this is part of our job: to define a line in a very grey
area, and if we go far beyond the line of 'accepting every test request'
(and possibly adding on further tests) we will finish up testing every
patient for everything because of fear of potential litigation (from patints
and directed to requesting clinicians as well as to ourselves), and
irrespective of the financial and human costs.
With best wishes to all
Gordon Challand
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