Add on tests can be somtimes timely to immediate
patient care. Take the example of the request sent by
a GP stating wt. loss, asthenia for U/Es. The MLSO
alerts you to a sodium of 120 mmol/L, potssium 6.2
mmol/L, urea 13.2 mmol/L and creatinine 87 umol/L. It
will be unethical if a cortisol is not perfomed on the
same sample urgently and the GP or deputising service,
is informed immediately. We are here to provide
consultative clinical service not pure analytical
service. If a consultant chest physician found a
testicular lump during routine clinical examination of
a patient presenting with a shadow on a chest X-ray,
no body will say it was unethical to examine the
patient's testis. As clinical people we follow leads
from history, clinical examination and investigations
and try to link them together to arrive at a final
diagnosis. The other point mentioned about applying
the correct test to the clinical details is also part
of our duty as clinical service. For e.g if
progestreone is requested to assess a patient with hot
fluses, we have to perform FSH instead and so on.
Don't forget that requests are usually generated by
junior doctors and nursing staff these days, who need
our help in this matter.
Mohammad
--- "Robertson, Stuart" <[log in to unmask]>
wrote: > It certainly can be a question of ethics.
> It could be argued that biochemical tests are
> investigations which require
> the informed consent of the patient.
> In the laboratory, we therefore make an assumption
> that the clinician
> requesting the tests has ensured that the patient
> knows what tests are being
> performed, and why.
> There are some circumstances where the approval of
> the requesting physician
> is essential before adding extra tests. Alpha-1
> antitrypsin is an example,
> where the clinician should refer back to the patient
> to counsel and obtain
> informed consent.
>
> Stuart Robertson
> Clinical Biochemistry Department
> Hull Royal Infirmary
> Hull
> HU3 2JZ
>
> (01482-607707)
>
>
> ----------
> From: Mainwaring-Burton Richard (RGZ)
>
[SMTP:[log in to unmask]]
> Sent: 25 September 2002 10:57
> To: [log in to unmask]
> Subject: Re: Ethics of add-on tests
>
> This is not a question of ethics, but
> relates to the future
> viability of our
> profession.
> If we do just what we are asked (where does
> one get CEA-125 kits
> anyway ?)
> we deny all our training and professional
> approach to our job.
> We have several duties to fulfil and should
> not be blindly driven by
> bits of
> paper. If we are so, we reduce ourselves to
> drones and deserve to
> succumb
> following the mating dance.
> We should apply our training and experience
> to address such
> situations, and
> if we are not able or prepared to do so,
> then we are not worthy of
> our
> claimed 'consultant' status.
> Our duties should include responsible
> management of resources as
> well as
> results, not to mention our
> responsibility to provide education to our
> colleagues and users of
> the
> laboratory.
> If we receive rubbish (perhaps uneducated ?)
> requests, we should
> contact the
> colleague (not just another idiot who chose
> to work outside the
> laboratory)
> and offer the proper services of the
> laboratory to conserve
> resources. If
> further tests are deemed likely, why not
> join in the discussion
> regarding
> the patient's treatment and see if we can
> portray our profession as
> worth
> promoting ?
>
> Sorry to rant a bit but are we mice or
> persons ?
> With best wishes
> Richard
> Biochemistry Department
> Queen Mary's Hospital
> Sidcup, Kent
> DA14 6LT
>
>
> -----Original Message-----
> From: Hyde Philip (ULHT)
> [mailto:[log in to unmask]]
> Sent: Wednesday, September 25, 2002 10:08
> To: [log in to unmask]
> Subject: Re: Ethics of add-on tests
>
>
> I would agree with the situation as
> outlined, Gordon. Furthermore,
> many
> requests may not be specific enough and need
> interpretation, e.g.
> "female
> hormones" or "hormone profile", commonly
> seen by us on female
> request forms.
>
> What do we do about other requests which are
> imprecisely annotated,
> e.g. we
> had a "CEA-125" requested recently in a lady
> with ca ovary. Does
> anyone have
> some specific legal case history to suggest
> we should just be drones
> and
> assay the test requested (however
> inappropriate) alone ? How much
> leeway
> does common sense allow us (in the UK, at
> any rate) ?
>
> Philip Hyde
>
> -----Original Message-----
> From: g.challand
> [mailto:[log in to unmask]]
> Sent: 25 September 2002 10:06
> To: [log in to unmask]
> Subject: Ethics of add-on tests
>
>
> In the most recent 'case for comment'
> distributed through UK
> NEQAS, HCG
> was added by laboratory staff to a request
> for FSH (which was low)
> on a 20
> year old patient with amenorrhoea. One
> participant has queried the
> ethics of
> 'add-on' tests.
> I suspect this is an area with very wide
> divergencies in
> practice. I
> think most of us would add on protein
> elctrophoresis for an elderly
> patient
> with back pain and high globulins; but few
> of us would add on HIV
> testing
> under any circumstances.
> What do people do in practice in their
> own laboratories. Are
> there any
> published ethical guidelines we should be
> following?
>
> Gordon Challand
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Dr. M A Al-Jubouri
Consultant Chemical Pathologist
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