Mohammad,
Thank-you for your comments and references, which I will study. However, I feel I have to restate my initial observations. If the UK is one of the few countries in the world that continues to employ pro-active interpretative reporting techniques, and very few other countries do, and if there is no evidence you can produce that patients in other parts of the world suffer, then indeed the onus is on you to justify the role of the UK reporting/interpretative Biochemist.
Ewan
Dr Ewan Bell
SpR Clinical Biochemistry
Gartnavel General Hospital
----- Original Message -----
From: Mohammad Al-Jubouri <[log in to unmask]>
Date: Thursday, April 22, 2004 11:31 am
Subject: Re: Role of the clinical biochemist (medical or clin. scientist)
> I am glad that SpRs are participating in this debate. If you mean
> by evidence as RCT, then no. But equally no other medical
> speciality have published evidence to justify their professional
> existence. There are however some case reports to draw your own
> conclusion from:
>
> 1. L Zendron, J Fehrenbach, C Taverna, and M Krause
> Pitfalls in the diagnosis of phaeochromocytoma
> BMJ, Mar 2004; 328: 629 - 630.
>
> 2. S T M Krishnan, Z Philipose, and G Rayman
> Lesson of the week: Hypothyroidism mimicking intra-abdominal
> malignancyBMJ, Oct 2002; 325: 946 - 947.
>
> 3. D A Oleesky and R Fifield
> Pitfalls in the interpretation of tumour markers
> BMJ, Jan 1996; 312: 183.
>
> Best wishes
>
> Mohammad
>
>
>
>
> "Bell Ewan (North Glasgow University Hospitals NHS Trust)"
> <[log in to unmask]> wrote:
> Mohammad,
>
> Can I ask you the opposite question? Can you show me evidence that
> patients who are being treated in health-care systems, that do not
> have an interpretative biochemist (most of the rest of the world),
> suffer as a consequence?
>
> Ewan
>
> Dr Ewan Bell
> SpR Clinical Biochemistry
> Gartnavel General Hospital
>
> ----- Original Message -----
> From: Mohammad Al-Jubouri
> Date: Thursday, April 22, 2004 10:00 am
> Subject: Re: Role of the clinical biochemist (medical or clin.
> scientist)
> > Trevor
> >
> > Before the interpretative/clinical role of the biochemist is
> > written off, we must know how good are the interpretative skills
> > of non-laboratory based clinicians of all grades including
> > consultants. With the increasingly wide range of tests provided,
> > do we know of a study or an audit (published or unpublished) of
> > the competency of clinicians (in primary and secondary care) in
> > interpreting various biochemical results.Are we assuming here,
> > that providing a numerical result with a reference range in
> > brackets and a computer generated H or L, is the best we can
> > provide for patients.
> >
> > Kind regards
> >
> > Mohammad
> >
> > Trevor Gray wrote:
> > Dear Colleagues,
> >
> > The comments from our transatlantic friends regarding the adding
> > on of
> > additional tests and the question from Craig bring up again the
> > role of
> > the laboratory and, specifically the clinical biochemist (whether
> > medically or scientifically trained or, for pedants, both) in the
> > authorisation function. Is it cost-effective to have expensive
> > manpowerdevoted to poring over results looking for useful add-on
> > tests (whether
> > or not consent has been given), and adding comments, which may
> or may
> > not be pertinent due to the lack of information. Our colleagues in
> > other countries (most of Europe and certainly the USA) do not
> > think it
> > necessary.
> >
> > It can be argued that all that is strictly necessary is for the
> > laboratory to be able to spot results which do not fit with clinical
> > details or that have changed in an unlikely fashion (delta check)
> > as a
> > sort of QA, and to make sure that critical results are phoned.
> As has
> > been mentioned, all that can follow computer protocols. Anything
> else> is a luxury for which there is scant evidence base. In many DGH
> > laboratories it isn't possible anyway, due to lack of staffing.
> We can
> > all quote cases where we have made a brilliant diagnosis on the
> > basis of
> > a not quite consistent set of results and the add-on test has
> clinched> it, although we have all probably missed twenty times as
> many.> However,the patient is the responsibility of the requesting
> > physician's not
> > ours.
> >
> > It became clear when Pieter and I did the survey of laboratory
> > computersand result authorisation (published in the annals a year
> > or so back)
> > that some computer systems do not have the fine tuning which enables
> > this sort of authorisation practice anyway. This was
> particularly true
> > for those originating from across the water, where only basic
> > authorisation functions are built in, although costing functions are
> > better developed.
> >
> > Craig's point is related in that the authorities (Trusts and
> > directorates mainly) expect us to be gatekeepers, which is
> unrealistic> in that, with electronic ordering (sorry requesting)
> we may be obliged
> > to abandon that function as the whole point is to increase
> efficiency> and the electronic order allows the sample to be
> processed more
> > rapidlywith less operator intervention. Adding back manual
> > surveillance of
> > requests in order to "gatekeep" is perverse.
> >
> > I'm not arguing that we do not have a function but that we are in
> > dangerof being left behind in the inexorable march of automation and
> > "modernisation". More rational requesting and more directed
> > guidance on
> > interpretation is possible with the use of information
> technology as
> > preached so eloquently by Jonathan Kay. Some of the simpler
> steps can
> > come with problem based requesting such as Elliot Simpson has
> > introducedin his northern neck of the woods. I confess that I have
> > greatdifficulty locally getting even simple measures adopted (as
> > for example
> > when using Troponins) and the information technological hurdles
> > seem to
> > get worse not better when we go to newer technology (well Apex
> is a
> > relatively new name though the basic system is about 20 years
> > old). The
> > challenge is to pool good practice in this area, before we all get
> > dragooned into a national IT system that edits us out.
> >
> > In the meantime, I shall continue to teach rational requesting (we
> > haven't much evidence yet to advocate evidence-based requesting) to
> > junior medical staff and continue to comment on results as the
> punters> (requesting doctors especially GPs) seem to value it.
> This will
> > includeadding tests on when they can "add value" to the result
> > provided by the
> > laboratory. So trainees needn't worry, I shall continue to have
> a pool
> > of "difficult" cases for the MRCPath ! Come to think of it, a
> strategy> for rational requesting for a particular condition would
> make a good
> > question......!
> >
> > But if we are going to continue to justify this use of expensive
> > manpower in a function which is virtually exclusive to the UK,
> who is
> > going to do the work to provide the evidence base for what is good
> > practice in this area - and collect all these ideas ? Perhaps
> some of
> > our dwindling academic colleagues in the profession could take
> up this
> > challenge ?
> > Trevor
> > --
> > Trevor Gray
> > Dept. of Clinical Chemistry,
> > Northern General Hospital,
> > Sheffield S5 7AU
> >
> > 0114 271 4309
> >
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