I agree. Black would be the day that a request for pathology tests is
likened to buying a pair of socks.
Surely a request for pathology is a request for a consultation. The patient
and the requesting doctor do not always know what tests are required in an
investigation. The request form must be interpreted with the experience
provided by achieving competencies fit for that purpose. In the arena of a
service financed by taxes, only appropriate tests should be done (demand
management) as there is a duty of responsibility to the tax payer.
Appropriate tests should be added as part of the consultation, and Financial
and Clinical Governance are obviously part of the decision process. It
would be inappropriate to add a string of tests that are not justified
clinically or financially. Equally it would be inappropriate to add a test
not related to the consultation. The line between appropriate and
inappropriate cannot be totally described by SOPs and requires staff to be
trained at a level fit for that purpose. As a rule of thumb, if I think I
can justify a decision to the requesting doctor, the patient, the finance
director, the medical director and the judge then I will do it. If I have
doubts I will phone a friend etc and then make a decision.
Of course if I were selling a product like socks then the more socks the
buyer wanted then the more I would sell, even if the buyer didn't need them.
The trouble is, without appropriate advice the buyer might spend all his/her
money on inappropriate numbers and types of socks, but that's business.
martin myers
-----Original Message-----
From: Mainwaring-Burton Richard (RGZ)
[mailto:[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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