Unfortunately, I would agree that the knowledge of those in your son's
position may well be greater than some more senior. I was trying to be kind
to those of our own seniority.
Although we may not always be in a position to make positive statements, we
are often able to make negative ones with very little further data.
What concerns me is the enormous increase in testing and the resultant
increase in false positives.
The old adage that the most important step in diagnosis was thinking of it
in the first place seems to be being replaced by a process whereby all
patients are 'screened' as a failsafe and any 'abnormal' result then
generates the 'thought' and leads to a search for meagre clinical signs
that, because of a marginal test result, are now declared abnormal.
One also has to accept that patients themselves often 'demand' tests, having
surfed the net. Mercury, PSA and red cell magnesiums immediately come to
mind. Others may use over the counter tests. Yet others get results from
screening services.
The result is no longer a traditional medical presentation but one beginning
with 'My test result was...'
I suspect that, if nothing else, we may be in the best position to suggest
the appropriate clinician for what is then 'further investigation'
I realise this is some way from the original question but it is part of our
future.
Trevor
> -----Original Message-----
> From: [log in to unmask]
> [SMTP:[log in to unmask]]
> Sent: 17 August 2000 16:05
> To: [log in to unmask]
> Subject: RE: Re[2]: giving pathology data to patients.
>
> I am not sure that Trevor's views differ from those of the legal advisor.
> The primary requester could legally be deemed to be the consultant in
> whose name the request is made and not the relatively inexperienced
> junior, to whom Trevor refers, who actually signs the form. (Having said
> this I would believe my "junior" son who recently worked as a house
> officer in Trevor's hospital than some of the consultants that I know).
> But the main point is that someone such as the duty biochemist is in
> possession of only a small part of the clinical information and cannot
> therefore always be expected to get the most likely interpretation.
>
> -----Original Message-----
> From: p=NHS NATIONAL
> INT;a=NHS;c=GB;dda:RFC-822=acb-clin-chem-gen-request(a)mailbase.ac.uk;
> Sent: 17th August 2000 16:43
> To: p=NHS NATIONAL
> INT;a=NHS;c=GB;dda:RFC-822=mike.ryan(a)uh.n-i.nhs.uk;; p=NHS NATIONAL
> INT;a=NHS;c=GB;dda:RFC-822=g.challand(a)dial.pipex.com;; p=NHS NATIONAL
> INT;a=NHS;c=GB;dda:RFC-822=acb-clin-chem-gen(a)mailbase.ac.uk;; p=NHS
> NATIONAL INT;a=NHS;c=GB;dda:RFC-822=mfreeman(a)powerup.com.au;
> Subject: RE: Re[2]: giving pathology data to patients.
>
>
> Presumably the Trust legal advisors believe that all requestors always ask
> for pertinent tests and always know how to interpret the results.
>
> We may rarely know the whole picture but we should be aware of the general
> applications of tests and their limitations.
>
> Very often the primary requestor is a junior with less than one year's
> experience and all of a few hours lectures in pathology on which to base
> their judgement.
>
> Trevor Tickner
>
>
>
>
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