The framework for personal injury litigation in general and its subset
medical negligence litigation in particular is somewhat different in The
Republic than in the either England and Wales or Scotland. The Republic is
in general a somewhat more litiginous society. Even so, the basic legal
framework that in order to recover damages a claimant (what used to be
called the plaintiff) has to show a duty of care on the part of the
defendant, a negligent breach of the duty of care and harm resulting from
that breach applies in all three jurisdictions. In the event of the highly
probably event of a result or two being outwith the reference range in a pan
(wo)man scan profile of tests, litigation will only result if the patient is
harmed as a consequence of the practitioner who requested the tests ignoring
the aberrant result. Even then the practitioner may not be liable if a
responsible group of practitioners rightly believe that the practitioner
concerned was negligent in ignoring those results.

The converse may be true. Doc A orders a pan man scan. Gets back a positive
fob and orders a colonoscopy. The colonoscopist pokes a hole in the large
bowel and the patient dies or, worse becomes permanently disabled as a
consequence... Was he negligent in ordering the colonoscopy? If you prefer a
more biochemical scenario, the doc gets back elevated transaminases and
orders a liver biopsy from which the patient bleeds out....

The practice of some practitioners in responding at spinal level to
statistical wobble in a large batch of largely irrelevant investigations
shouldn't happen but it surely does. When was "Beyond Normality" published?
How can we inculcate a bayesian approach to test interpretation in our
customers who only see the asterisked results. I don't know. I can only
agree with Andrew Raftery FRCS, the surgeon who raised the hare about
inadequate scientific knowledge in the medical students doing the new fast
track course, when he said "Young doctors today know all about the
management of bereavement and the square root of ****** all about the causes
of bereavement". What is needed is less touchy feely stercor in
undergraduate medicine and more on the scientific basis of medical practice.
That includes not only the basic clinical sciences, which include psychology
and sociology, but also a sound statistical appreciation of the basics of
laboratory medicine. At present, I fear the young vets who treat my cats
when sick have a better scientific approach to their craft than some of the
young (and not so young) doctors floating around.

Robert Forrest

> -----Original Message-----
> From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]]On Behalf Of Grimes, Helen,
> UCHG
> Sent: 05 February 2003 17:29
> To: [log in to unmask]
> Subject: Re: Test requests
>
>
> More people are being tested, as the emphasis on Health Promotion, annual
> check ups etc means that "well" individuals are seeing their doctors. The
> more people tested, the more one can guarantee "abnormal" results, defined
> as any part of a unit above or below the "stated " ref range. A doctor has
> to further investigate all "abnormal" results, due to medicolegal
> implications, and so the "well" individual is now a patient. The
> busier the
> laboratory, the more we rely on profiles to enable us to process the work,
> so this increases the ratio per sample. Some labs will insist on separate
> samples for TFT, PSA etc, which can reduce the ratio per sample, in
> comparison to the laboratory who tries to do all on one sample.
> If you are a
> teaching hospital, where patients are scattered throughout wards, and
> "daily" requests are made by the interns, so that they have all the
> information at the Consultnat's round, then that gives a high patient/test
> ratio. Surely, currently the only meaningful comparison between
> laboratories
> is individual number of a specific test, and perhaps grouped according to
> automated instruments. Does it also highlight how poor our computer
> managment information is?
>
>
> ____________________________________________________________
>
> Dr. Helen Grimes, Dept. of Clinical Biochemistry, UCH, Galway, Ireland
>
>
> -----Original Message-----
> From: David Brown [mailto:[log in to unmask]]
> Sent: 05 February 2003 10:52
> To: [log in to unmask]
> Subject: Re: Test requests
>
>
> Thanks to all who replied to my mail regarding patient
> test request ratios.
> The consensus seems to be people don't have time or
> the computer resources/design to calculate them. Too
> much emphasis is put on "depends what you mean". I am
> aware there is more to just counting test numbers, due
> to local factors, staffing levels, equipment used,
> complexity of analysis etc. But a test is a single
> analysis, a request is the piece of paper on which
> they are written,and a patient is the person on whom
> the request and the tests are performed.
> This question arose from a previous debate on ever
> increasing laboratory workloads, but it appears it
> isn't important to identify whether this is due to
> more tests per patient or more patients having tests
> done (or a combination of both?).
>  Remember someone in the government has said the NHS
> is under strain, not because of resources, but because
> more patients are being treated than ever before.
> Many labs fear they are becoming nothing but "number
> crunchers", but it appears they won't even know what
> numbers they are "crunching".
>
> Thanks
> David Brown
>
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