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ACB-CLIN-CHEM-GEN  October 2008

ACB-CLIN-CHEM-GEN October 2008

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Subject:

Re: An interesting comparison...

From:

gordon challand <[log in to unmask]>

Reply-To:

gordon challand <[log in to unmask]>

Date:

Wed, 8 Oct 2008 18:00:45 +0100

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Dear colleagues
I am feeling somewhat of an old lion in this arena, but think it's probably 
about time I contributed to this thread. I think there are three separate 
issues to be considered.
1. Is there a fundamental difference between different aspects of clinical 
support services. Is radiology (predominantly producing images) 
fundamentally diffeent from Clinical Biochemistry (predominantly producing 
numbers)?
I don't think there is (but perhaps I may be biased by twice as a patient 
having been mis-diagnosed by Radiology (one pre-analytical, one 
post-analytical error). Radiographers do their best to produce accurate 
images, our technical staff do their best to produce accurate numbers (as 
well as some producing accurate images). Whether or not the images or 
numbers are accompanied by interpretation depends on local circumstances and 
the setting (A & E out-of-hours emergencies vs a non-emergency inpatient 
hospital setting for example). For Clinical Biochemistry, in the UK very few 
labs produce numbers in isolation, the numbers are almost always accompanied 
by at least a reference range (which may or may not be appropriate taking 
into consideration age, sex, ethnic origin, patient preparation and setting, 
and everything else). By providing a reference range we inevitably provide a 
classification into 'normal' or 'abnormal' which is the start of 
interpretation.
2. Can we rely on present-day clinical stuff accurately interpreting the 
data which clinical support services provide?
Several respondents have pointed to the lack of training in our medical 
school curricula; and I think we are all aware of many pre- and 
post-analytical errors virtually outside the control of the lab contributing 
to mis-interpretation and mis-diagnosis of patients. However this isn't 
solely confined to junior clinicians; I despair when locally our older 
clinicians dismiss as 'laboratory error' results which contradict their 
pre-determined diagnosis. In the UK there is also increasing reliance on 
'Nurse Practitioners' as the front line for investigation efforts in both 
primary and secondary medical care - these desperately need help from the 
lab.
3. How do we best use our time to ensure the best possible patient care from 
our efforts?
We are all professionals, and woudn't be working in this area if we did not 
have the interests of patients at heart. It is a matter for each of us to 
find the best local solution depending on local circumstances and demands. 
There is no right answer between expending most effort on a relatively few 
hospital in (or out) patients (perhaps through visiting or phoning); or on 
expending most on a larger number of primary care patients (perhaps through 
commenting on reports as they go out); we would all like to do both 
simultaneously, but we are all human and time is limited. Where we draw our 
activity line in this grey area is down to our personal decision; we cannot 
say a line drawn in one area is 'right' and another one is 'wrong'. The 
bottom lines are that adequate communication (and also trust) between us and 
the clinicians is vital (whatever form this takes) and that the best service 
possible service to our patients is the bottom line to the equation.
With best wishes
Gordon Challand 

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