This is an excerpt from an Italian scientist replying to me on the reasons why the various tests are not properly controlled by the companies selling them:
He describes the way the various groups don't communicate with each other and therefor have no interest in getting the tests harmonised:
Basing on my daily activity with both “pure” laboratory medicine specialists and “pure” clinicians I realized this “disinterest” comes from different and rarely communicating cultures and practices;
(1) some (or many) clinicians are not aware of laboratory problems and criticisms. They take results and reference ranges provided by laboratories and, in general, consider as “true” those results fitting their clinical impression/suspicious. In case of clinically unexpected results, however, they frequently label them as “laboratory errors” and retest (frequently in another laboratory).
(2) some (or many) laboratory medicine specialists embark, in front to inconsistent results, in time-consuming procedures when a phone call with the attending physician, asking some focused details, may frequently solve the conundrum reinforcing the relevant role of laboratory specialist in patients’ management, well beyond “numbers” production. (3) Rarely, clinical guidelines’ panels include laboratory medicinespecialistsand viceversa.I’malways concerned when clinical guidelines recommend a fixed cutoff as clinical yard-stick, without considering inter-assay variability and other analytical problems. On the other hand laboratory guidelines focus on analytical problems and emphasize limitations of available test but rarely provide practical input on how to survive with tests’ “imperfections” when faced with patients in daily practice.
Such issues are all relevant in the context of ongoing standardization initiatives but waiting for better and more consistent analytical results we need to optimize the, admittedly not so bad, currently available laboratory outputs to better survive and well serve our patients now. From the clinical point of view, using appropriate criteria when selecting clinical test is certainly useful to avoid most inconsistent “in vitro” results without clinical relevance. When multiple test (as thyrotropin and free-thyroid hormones) is required in the absence of relevant history and clinical picture, the first question is not “why this strange result?” but “why this inappropriate request?”.
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