PURPOSE OF A DIAGNOSTIC LABORATORY

Dr.T.V.Rao MD
Today we have many Institutes and Medical Colleges, who train the Medical personal for
advancement of education for awarding MD Degrees, already many finding underemployment and
unemployment, The reasons can be many we failed to translate our knowledge to the benefit of
patients, Almost many Medical colleges are set up with an idea of profit and least inputs in
Academics and research, it is not alone the system the Physicians many times fish the diagnosis
without knowing the purpose of a Diagnostic test, Nobody educated on this matter to treating
doctors and clinical Microbiologists, The clinicians should know when to order a Test Ordering and
interpreting diagnostic tests are fundamental skills which the treating physicians should know or else
it is an empirical diagnosis with drain of resources without purpose . Surprisingly, however, evidence
indicates that many of us are poorly trained in this vital area. Studies have shown that physicians
commonly order more laboratory tests than required, use them for the wrong purposes, (KICK
BACKS) and ignore or misinterpret their results. While these errors have obvious implications for the
quality of patient care, there are large socioeconomic implications as well. When we were studying
Text book of microbiology we learnt to words in Immunology and Antigen Antibody reactions 1
Sensitivity and 2 Specificity, if we know these two words in depth, it is a great foundation to
Laboratory Medicine, and the sensitivity of a test refers to the proportion of patients with a given
disease who have a positive test. The specificity of a test refers to the proportion of patients without
the disease who have a negative test. Predictive value, on the other hand, refers to the likelihood
that a patient has or does not have the disease, given positive or negative test result, the purposes
for which tests are obtained have a great dealt do with both the choice of diagnostic test and its
interpretation.* One survey of physicians in a large teaching hospital found that three general
reasons accounted for most laboratory test ordering: diagnosis (37%), monitoring therapy (33%),
and screening for asymptomatic disease (32%).The Microbiologists and Physicians should know how
the diagnosis helps to be positive in a large proportion of patients with the disease (high sensitivity)
and negative in a large proportion without the disease (high specificity). Ideally, for the test to be
maximally useful for diagnostic use, both sensitivity and specificity should be 100%. This would mean
that every patient with the disease would have a positive test (no false negatives) and result in a
negative predictive value of 100% .Similarly, positive tests would occur only in patients with disease
(no false positives), resulting in a positive predictive value of 100% . Unfortunately, tests with such
high sensitivity, specificity, and predictive value are unheard of, In fact, tests with high sensitivity
tend to have low specificity, and vice versa. A little thought, however, will allow you to choose the
proper test for your particular diagnostic purpose. Never forget the cost of Medical treatment
increased with ignorance and doing irrelevant investigations much of the costly tests, misuse and
misinterpretation of diagnostic tests is due to the fact that physicians are not always able to manage
intuitively the probabilistic information that most laboratory tests provide. The diagnostic process is
one of successive probability revision. Knowledge of the operating characteristics of laboratory tests
(i .e. sensitivity, specificity, and predictive value) can greatly facilitate this process .Knowledgeable
use of these operating characteristics allows test choices to be tailored to the specific purposes of
diagnosis, monitoring, and screening. In addition, such use allows proper interpretation of normal
test results, as well as discriminate use of common strategies such as screening, rule-out testing,
repeating tests, and combination testing. I am bold to confess the many times the treating
physicians do not put thought when ordering the test, and leave alone what it means if it is negative
or positive, Most of the Times the reasons to investigation are not scientific, and in this process no
competent laboratory specialist can interpret tests. The conditions are no better in Teaching

hospitals may be worse all matters are left to House surgeons and trainee nurses, Never forget the
laboratories are fishing places the professionally run laboratory will support your scientific diagnosis
rest is a Trial and error on human guinea pigs ? After having qualified specialists there will few
details on requisition form to guide the laboratory THE GREAT QUESTION CAN WE IMPROVE OR
LABORATORIES? FISHING FOR DIAGNOSIS IN LABORATORIES CAN BE DANGEROUS?
*Ref Use of the Laboratory CRAIG KAPLAN and Google image resource
Dr.T.V.Rao MD Professor of Microbiology Freelance Writer