NEW PERSPECTIVES ON THE CLINICAL VALUE OF LABORATORY
Roberto Verna, MD, PhD
Professor of Clinical Pathology
Department of Experimental Medicine, Sapienza University of Rome, Italy
President of the World Association of Societies of Pathology and Laboratory Medicine – WASPaLM
The goal of this presentation is to highlight the importance of professional skill and training in the definition of which laboratory test is really useful to the clinic.
Medical School dedicates a lot of time to Anatomic Pathology, a little less to Radiology, very few time to Laboratory Medicine, but in the everyday practice, a doctor will face a large amount of Clinical Laboratory Tests, several Radiology tests and a very small number of Anatomic Pathology tests.
Many names and abbreviations are used for the same test, so that we should be certain that the ordering doctor really wanted the correct test. Actually, tests are ordered and data are tossed over the wall to the physician responsible for synthesizing clinical and laboratory data to achieve a diagnosis. The new approach must be: Physicians order tests by requesting evaluation of abnormal screening test or clinical sign or symptom.
The main problem in Countries is how to save money in public health. The cost of laboratory is no more than 3% of the global expenditure, while improper admissions to clinical departments reach 15%. But the only (or at least the main) provision that is adopted is the random reduction in the budget for laboratories, trying to reduce the number of lab tests. This goal in some Countries has been obtained through the reduction of the number of laboratories and with the establishment of the so-called large areas, in which millions of tests can be carried out. If this, on one hand, may lead to a decrease of the cost of the single test, as a consequence of economic considerations, on the other hand may lead to a lot of problems, mainly the lack of communication with the ordering doctors, that, in turn, would lead to increase the number of tests.
An example of the strategy for money saving is the following: if the total budget of hospital is 3 billion, with 3% of healthcare lab tests, there are two possible directions: 1) one third reduction in lab tests, leading to 2% of the expense for lab tests, that reduces the hospital budget to 2,97 billions, OR, 2) increase lab tests by using useful tests that allow a more rapid and accurate diagnosis. This increases the expense for the lab to 4%, but reduces the budget of hospital to 2.5 billions with an important general saving.
This is inherent in the concept of appropriateness: To Do What Is Useful When It Is Useful.