JISCMail - ACB-CLIN-CHEM-GEN Archives

I would like to avoid a competition over how rigourously we may or may not validate and QC methods, but I have to disagree when it comes to interpretation. Whilst AA, GCMS & LCMS may take more time to interpret and involve taking into consideration multiple parameters before issuing a single report, biochemistry 'numbers' from routine analysers require interpretation and I believe that all too frequently they are dismissed as 'simple'. How often are raised tumour markers (eg ca125) taken as a reason to play hunt the tumour when they can be raised by a plethora of non-malignant causes? Likewise, the interpretation of sodium results is often poor, particularly when looking for causes of hyponatraemia, the difficulty the laboratory has in interpreting these results is the lack of clinical information, whereas the difficulties in interpreting results on the wards are due to a lack of understanding of the tests (nevermind delving into assay interferences). Radiology would never accept a request without sufficient clinical information to enable them to produce a sensible clinical report, maybe we should try to improve the level of clinical information we receive with our requests so that we can issue informed reports that provide accurately interpreted information and avoid 'number' mis-interpretation on the wards. This may provoke hostility with regard to how time consuming it would be, but perhaps requiring requestors to provide details as to how a laboratory report is intended to inform them, it would also reduce a significant amount of unnecessary testing.

Kind regards,

Adam

Nottingham University Hospitals

From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Elizabeth MacNamara
Sent: 06 October 2008 21:13
To: [log in to unmask]
Subject: Re: An interesting comparison...

I am sorry Francis I can not agree with you and I can see you have never been in my laboratory or have any understanding of the way I or my staff work. I probably to twice the amount of QC and validation you do in your laboratory, I ensure everything is checked by more than one methodHowever, if an analyser produces 14,000 results a day it is not the same as a radiologist reading CT, MRI or XRays. It is is also not the same as us reading an immunofixation or a complex AA, GC_MS, LC-MS etc, result. Our work is very important but we do not have to pretend that automated chemistry results are the same as tests requiring interpretation be they from our laboratory or radiology, they are not.

Elizabeth

Frances Rosenberg wrote:

[log in to unmask] type="cite">
Wake up and smell the roses!

Do you installed a chemistry analyzer and rely solely on the manufacturer supplied information to provide reference information (a process for which the manufacturer undoubtedly issues a disclaimer)? If that is your usual practice, then I agree there is a difference between your laboratory report for core biochemistry and a radiology report.

However, if a member of your professional staff (versus your reliance on the manufacturer) takes responsibility for the information conveyed by the test report (which may extend beyond RIs and include standard interpretive comments) then the distinction between radiology and biochemistry becomes blurred. This is the situation where I practice. We scrutinize manufacturer supplied information and pursue various avenues to validate/replace/supplement that information.

It may be that your response reflects how you practive laboratory medicine or you may not have reflected sufficiently on the issue.

Frances Rosenberg MD PhD FRCP(C)
Medical Biochemist
Pathology and Laboratory Medicine
St. Paul's Hospital Vancouver BC V6Z 1Y6
Phone (604) 806-8190 Fax (604) 806-8158

-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]]On Behalf Of Elizabeth Mac Namara
Sent: Friday, September 05, 2008 8:19 AM
To: [log in to unmask]
Subject: Re: An interesting comparison...

I completely agree with the statement: A radiology report is an interpretation and the result from a biochemistry analyser is not. A protein electrophoresis and immunofixation report is an interpretation and neither is it analogous to a printout of a biochemistry analyser. I do not see giving a biochemistry results to someone the same as discussing them with them. I am not quite sure people are so upset.

Elizabeth Mac Namara
Jewish General Hospital
Montreal

[log in to unmask] type="cite">
Date: Fri, 5 Sep 2008 08:32:28 +0100
From: [log in to unmask]
Subject: An interesting comparison...
To: [log in to unmask]

http://www.bmj.com/cgi/content/full/337/aug11_1/a785

"A radiologyreport is much more than simply the result of a test. It is not analogous to the print out of a biochemistry analyser butshould be a fully informed clinical decision"

Jonathan
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------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/

------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/

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ID:QMCICT1 - B48eb139a0002.000000000001.0001.mml - 08:45:30 10/07/08