Interpreting lab tests

4 Feb
2008

My students and residents know that my eyes light up and I get visibly excited when the patient has abnormal laboratory tests. I have always enjoyed understanding these major clues to the patient’s diagnosis.

This BBC article suggests that not all physicians understand test interpretation -Test confusion ‘risk to patients’

Many junior doctors do not understand common hospital laboratory tests and are putting patients at risk as a result, biochemists have claimed.

The Annals of Clinical Biochemistry reports that 18% of more than 80 junior doctors surveyed were happy to order a test they could not fully interpret.

The Association for Clinical Biochemistry blamed poor teaching of the subject at medical schools.

The General Medical Council is planning to review its curriculum guidance.

The majority of hospital pathology tests are ordered by junior doctors, but in recent years many medical schools have reduced the amount of time they devote to pathology teaching.

Dr Trevor Gray, from the Northern General Hospital in Sheffield, carried out a survey of more than 80 juniors, asking them how they felt about the clinical biochemistry tests they were expected to order on a day-to-day basis.

In 10 out of the 12 common tests listed, some of the juniors questioned said they were not entirely confident about interpreting the results.

I agree with the observation, but I disagree with the diagnosis and treatment. Learning to interpret laboratory tests requires clinical context. Even a great preclinical course will not solve this problem Clinicians must explicitly include laboratory test teaching in their discussion and analysis of patients.

Now this requires that the clinical faculty are fluent in laboratory test interpretation, and that they know how to teach. I regularly spend time with my team or at morning report analyzing the laboratory test data. (In fact, many residents seek me out with test abnormalities.) If clinical educators are not teaching test interpretation, then I would focus on that lesion, rather than altering the preclinical training too much.

Test interpretation is taught best from case studies. This represents the rationale behind my interesting cases series on Medscape.

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6 Responses to Interpreting lab tests

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Louis Cornacchia, M.D.

February 4th, 2008 at 1:00 pm

I think you are absolute correct.
I think that this type of learning should occur on the job.
CME should be tailored so that it occurs as needed and is tied to specific areas that the doctor needs to improve

Avatar

S Bjorklund

February 4th, 2008 at 2:26 pm

DB – Thank you for recognizing the importance of lab-test interpretation.

This is a problem that is not new and even some veteran physicians, not just juniors, have difficulties interpreting tests and especially staying current on new tests with all that’s on their plate.

ARUP Laboratories in SLC, Utah recognized this ever-growing problem and created this free online resource to physicians called ARUP Consult – The Physician’s Guide to Laboratory Test Selection and Interpretation. http://www.arupconsult.com

This powerful tool provides point-of-care lab-test selection and interpretation, algorithms, links to PubMed and concise diagnostic advice.

I hope this helps you with empowering your students and residents with great lab-test information and interpretation to better their patient care… which is our ultimate goal.

Avatar

DermDoc

February 4th, 2008 at 8:25 pm

Great post. And thank you S Bjorklund for the ARUP consult link. I looked at the immunobullous skin disease algorithm; it’s quite good.

Avatar

Denis Benjamin

February 4th, 2008 at 9:57 pm

As a pediatirc and clinical pathologist, who has devoted an entire career to helping clinicians at all levels of training and experience interpret laboratory results and utilize the laboratory effectively, I was surprised that only 18% had little clue what they were ordering. My standard mantra to medical students and junior faculty is that ‘ordering a laboratory test is like picking your nose in public. You better know what you are going to d with the result.’

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Hildy

February 6th, 2008 at 1:24 am

During my last year of medical school, the head of chemical pathology at my hospital ran a series of small group tutorials on interpreting lab tests. Absolute gold in terms of recognising pitfalls (the normal abnormal, the abnormal normal, etc).

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Jan Krouwer

February 6th, 2008 at 4:20 am

I wonder how often doctors question whether the test is correct (lab error), which can be considered as an interpretation. There is a well known case, where a woman was treated for trophoblastic carcinoma (chemotherapy, hysterectomy, partial removal of one lung) on the basis of elevated hCG results (45 tests in all). Finally, lab error was suspected and confirmed (there was an interference in the assay). Is there data on physician requests for repeat testing?

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