ARE THE MEDICAL LABORATORIES A RISK TO OUR LIVES?

Changing world of Laboratory Medicine

Dr.T.V.Rao MD
The proliferation of Evidence based Medicine has encouraged the growth of laboratory Medicine,
however it is certain that No physician treats the patients without the support of the laboratory,
Unnecessary tests are often ordered to buy doctors time when they don't know what is going on.
Today the laboratory system is becoming a greater human risk the word RISK is a derivative from
Latin riscare (to dare). Risk Management became reality when humans realized that they could dare
the gods and aspire to their own goals. Peter L. Bernstein against the Gods: The Remarkable Story
of Risk. I come across great physicians who use laboratory as servant and unfortunately today
laboratories have become fishing places for hiding the ignorance of physicians, who least care to
read the clinical medicine . Doctors who are bewildered or uncertain may simply hide behind
technology and order more and more tests in the hope that this scatter gun approach may prove
effective. The days of a shotgun approach to ordering laboratory tests has, of necessity, been
replaced by a rifle (or targeted) approach based on an understanding of the tests diagnostic
performance and the major legitimate reasons for ordering a laboratory test. Such an
understanding is critical to good laboratory practice and patient outcome the condition of the
patient becomes almost irrelevant as the doctor searches endlessly for the ever elusive diagnosis.
Laboratory test results may influence up to 70 percent of medical decision making. It becomes
apparent there are many false positives and false negative results that lead to wrong diagnosis and
poor treatment decisions and poor patient outcomes. However, one must wonder whether the test
results are being interpreted correctly, andif notwhat the impact is of incorrect or inappropriate
interpretation on the accuracy of diagnostic decision making based, in part, on laboratory test
results. Today on a physicians table we rarely find any reference books related to the specialty and
find many pads to write laboratory requests. Medical Institutes and Medical colleges are centres
where the physicians act to be academic Doctors sometimes order tests in order to impress their
patients, their colleagues, their students or themselves. It is fairly common these days for doctors to
order unnecessary tests because they are planning to write a paper for a scientific journal and need
lots of data to fill up the pages and build up their reputations. Most of the papers published in
scientific journals are of little or no clinical value and so yet again patients are investigated
unnecessarily some of the Doctors convert everything into academic paper, today most of the
scientific papers published are of no value to any one, if believed a real threat to life Finally, doctors
frequently perform tests out of habit. So for example, patients who are in hospital will often have
daily tests done even though a daily change in a specific test is unlikely to lead to a daily change in
the treatment recommended. When this happens diagnosis and investigation have been divorced
from treatment. The real risk lies in the fact that the more often tests are performed the more likely
it is that there will be one or more results showing a new and abnormal result - and that the new,
abnormal result will inspire doctors to introduce another element to the treatment program, Too
Many Tests, cross consultation and conflicts of interests of the treating physicians can not only a life
threat but can the drain of resources of the poor patients
The problems associated with tests and investigations are made worse by the fact that doctors
undoubtedly order far too many tests. Inevitably, this leads to more false positives - and even more
unnecessary treatments.
At least two thirds of all the tests and investigations ordered by hospital doctors and general
practitioners are unnecessary.

Routine blood and urine tests help doctors make a diagnosis in only around 1% of cases. It is more
habitual writing rather than on any basis,
And routine sampling for microbiological testing is unnecessary. One survey showed that only in
three per cent of cases was the treatment given based on the result of culture and antibiotic
sensitivity. If the analyse many case reports, today many physicians are using end stage new
generation Antibiotics and then searching for culturing will be counterproductive, and makes
patients poorer than recovering from the existing problem
Too Many Doctors Are Dependent on Tests, a paradox impossible to Correct
Many doctors have become totally dependent on tests of one sort or another. They feel incapable of
making any sort of clinical decision unless they have done a vast range of tests. And they put more
faith in the results they obtain from the laboratory or the X ray department than they do in their
own clinical skills.
Whenever a doctor plans to do tests or investigations of any sort ask him how the tests or
investigations will affect the way he treats you.
If he tells you that the test isn't going to affect the treatment (or lack of it) then the test may not be
worth having.
It is, of course, always worth remembering that tests can cause serious health problems - and can
kill.

The Bottom Line

The bottom line is that you should remember that tests aren't as reliable, as useful or as necessary
as most people think they are.
If you feel ill when tests have shown that there is nothing wrong with you then you should listen to
your body and ignore what may well turn out to be `false negative' tests.
If you feel well when tests have shown that you have a problem which needs treating just remember
that there is a chance that you are feeling well because there isn't anything wrong with you - and
that it is the laboratory test equipment rather than your body which needs treatment.
The most wrong thing associated with Laboratory system is the wrong and ignorant expectations of
treating physicians losing all the wisdom of learning and practising clinical Medicine for even after
many decades of training leading to many clinical misjudgements.
A country like India the laboratories have become a source of Income and kickbacks to many
unscrupulous Doctors and laboratory managers who live on commissions than on the practice of
Clinical medicine if I look back the Diagnostic Microbiology the system is fast degenerating due lack
of dedication and lack of funding in the technology, people having no experience in basic Medical
Microbiology recruited as laboratory technicians, junior laboratory specialists are entrusted with
impossible tasks we never know what really the clinicians understand from the laboratory services If
we sincerely think to do a sincere investigation needs a deeper dedication and investments The
Indias great problem with emerging drug resistance continues to attributed the ignorant laboratory
personal reporting normal at pathogens, and testing all the Antibiotics, If the matters are not
understood in the right direction many people die of ignorant physicians decisions corrupt
laboratories and doctors getting rich on Kickbacks kill many innocent people who are truly not
patients,

I WISH MANY DOCTORS WHO WISH TO JOIN LABORATORY MEDICINE SHOULD READ THE
ARTICLE DECIDE WHAT TO DO IN FUTURE WITH THE QUALIFICATION IN DETERIORATING
ETHICAL STANDARDS I WISH MANY TO READ A GREAT NOVEL BY ARTHUR HAILEY THE
FINAL DIAGNOSIS.
It is a fact many may not agree, Ignorant Doctors and improperly equipped and least cared
laboratories kill more people than the Disease, After many decades in the Laboratory I
think it is great comedy to work in the changing world, just enjoy or we are lost?

Ref1 Clinical Laboratory Tests: Which, Why, and What Do The Results Mean? Frank H. Wians, Jr.,
PhD, MT (ASCP), DABCC, FACB
2 Hospital And Laboratory Tests Can Be Wrong, Vernon Coleman 2003
Dr.T.V.Rao MD Professor of Microbiology free-lance writer