Going back nearly a decade when we were always 'Challenging the paradigm'
should we not begin again with some thoughts on what we are trying to
achieve and how?
The view expressed by Mike Collins that patients should have more direct
access to their results could well gain ground and, together with
initiatives such as labtestsonline, would create a need for more direct
laboratory patient interaction.
We also need to recall that whereas laboratory testing was complex in the
days when the current medical decision paradigm was established (in the last
quarter of the 19th century) it is now one of the most efficiently delivered
data elements in the process.
Most of our test interpretation has been based upon specific clinical
situations. There is very little information on how our invetsigations work
in non-specific circumstances or (as is frequently their actual use) as part
of an 'admission' profile.
Are there tests that shorten the decision process by use before the clinical
element? If there are (and I suspect that there will be several) then we
need to encourage their use so that the more expensive parts of the process
(the history and examination) can be shortened or even dispelled altogether.
It could well be that rather than too many tests being requested, there are
far too few.
We need to know because if we are to deliver a service in an efficient and
professional manner we need to know just what that service should be.
We all have pressure on resource, especially time, that increases annually.
We could easily deal with our difficulties if the workload was controlled,
or batched and centralised. The downside might be less efficiency in other
parts of the medical process.
We know that the Government wants reduced waiting lists and better outcomes.
So do we all. Pathology modernisation should be set against its ability to
deliver these objectives in a sustainable manner.
Does anyone know if the DoH has any idea how to model the benefits of
modernisation proposals against such desired benefits, or will it really use
some form of productivity as its benchmark?
Trevor Tickner,
Norwich
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