While we can diagnose many patients based on history and physical exam, sometimes we must turn to the lab for help.
Physicians order lab tests regularly. However, many experts believe that too often we do not alway interpret the lab tests. Over 3 years ago I linked to this article - Test confusion 'risk to patients'
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.
These paragraphs are not an exaggeration. Almost daily we have students and residents who do not have a deep understanding of lab test results.
Master diagnosticians view laboratory tests as clues. They understand the physiology that influences the laboratory tests. They understand the BASIC SCIENCE of lab test interpretation – sensitivity, specificity, likelihood ratios and receiver operating characteristic curves.
Great diagnosticians use lab tests to further understand what has happened to the patient. Some diagnoses are made through lab test interpretation, while other diagnoses are confused because the physician misinterprets a result.
As educators we must make certain that our learners become skilled at lab test interpretation, including what tests to order for a variety of complaints.
{ 2 comments… read them below or add one }
Should a step prior to lab interpretation be lab selection. Many doctors dont understand when to use a sensitive vs a specific test nor do they know the sens/spec/LRs of the tests they commonly use.
I worked with one of medicine's great diagnostician, labs were like water to a thirsty doc. He loved a display I did of multuiple labs shown over the course of care along side meds and other radiology and tissue pathology in a graphical timeline format. Given that display he was almost always right on Dx and treatment. I wonder why this sort of display has not been offered for medical data.