The flip side to all this is whether a laboratory consultant could ever be
held negligent for FAILING to add a test. When I put this to the Medical
Protection Society a couple of years ago (in relation to pregnancy testing)
they said the primary responsibility for picking the right tests lay with
the requesting doctor, and as such the laboratory only need do the tests
asked for. The gist of the letter was also that additional testing was a
welcome and useful service, but that a clinician should not rely on the lab
to get them out of trouble. Interestingly, the issue of obtaining consent
was not mentioned.
There are several further observations I would make:
1. Everyone so far has assumed a doctor is the initiator and receiver of the
test. Increasingly requests are coming from nurses and other health care
staff. How can any patient be said to have given informed consent to even
the primary test if the requestor has not had any training in laboratory
medicine? (This will become an issue even for doctors in the future as the
curriculum progressively cuts out the science base)
2. Most requests are not for diagnostic purposes, but for evaluating or
monitoring known conditions.
3. Do histopathologists or haematologists ever worry about special stains or
films picking up unsuspected malignancy? If not, why should we?
4. Instant communication between the lab, requestor and a well-informed
patient would be the ideal, and with developments in email & mobile comms,
this might eventually be achieved. But how many more of us would it need to
provide such a personalised service?
5. I suspect that the first patient suing a lab director for the distress of
an unwanted additional test would be laughed out of court. (But I am not
myself volunteering!)
6. This is not a black and white issue: no-one would object to adding Mg or
bicarb to samples with hypoK, for example, but equally no-one would add an
unsolicited HIV test. So where is the line drawn, and by whom? Personal
ethics, local agreement or national policy?
Dr Paul Masters FRCPath
Consultant Chemical Pathologist
Chesterfield Royal Hospital, S44 5BL
01246 512212
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