We can no more hold back the tide of increasing requests than King Canute could hold back the sea. We just have to live with it and fight for our share of the resources with everyone else. The political drive for one stop assessment and 4 h maximum waits in A&E are actually driving us back to the days before discretionary analysis. Even if a nurse follows the protocol for the presenting complaint the junior doctor invariably requests a host of "add on" tests (which may be entirely justified). The extra aggravation this causes means we might as well do everything in the first place. We might buy a SMAC next time...
No strategy employed by the lab can reduce requesting.
Clinical budgeting: Had it for years in Chesterfield. Requests increasing at the same rate as everywhere else. (Although the overspend belongs to other directorates, not us).
Protocols: Always have a get out clause, eg "this does not replace clinical judgement" And the judgement is add another test or three.
Education: There aren't enough of us to deliver this (even if the Med Schools were remotely interested). See Profession Under Siege.
Intelligent requesting from remote terminals. I am sure the technology exists, but getting it into the NHS? Give it another 10 years.
Paul
Dr Paul Masters
Consultant Chemical Pathologist
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