A couple of centuries ago, when I was a graduate student in biochemistry and later a med tech, we thought about a lab test as a CBC or a blood sugar that produces a numerical result. Period.
Later, I learned and wrote that there were at least nine separate vital steps in the performance of a laboratory test and that the analysis that produces a result was important but that so were the other eight.
A laboratory test begins when a person’s brain, usually that of a physician, but it could be a patient or some other healthcare professional, decides that it would be a good idea to have a lab test and “orders” it.
After the order, a process results in collection of the specimen, identification of the patient and the specimen, and transportation of the specimen to some location, near or far, where it is received and prepared for analysis.
The result is reported directly or via computer or some other method, like a fax or a telephone call or even, in some instances still, by snail mail. The receiver, hopefully the person who placed the original order, then interprets the result.
After that interpretation, some action is taken. The most usual action is no action, which is, of course, an action.
I learned some 40 years ago, that if anything goes wrong with any part of this chain and the lab testing gets screwed up, it is considered a “lab error.” It almost goes without saying that broken lab tests have forever been one of the main forms of error in medicine.
Thus, since I as the lab director was going to blamed for any glitch in the process, I figured I might as well take charge of as much of the process as I could. That way I had a chance to make it all work well, and if there was a broken link, I really could take the blame and try to fix it for the next time.
A lab test from the physicians’ brain to the physicians’ brain.
A closed loop that can be very important when it works right, and either a waste or a tragedy if it does not.
George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.