Dependency on

laboratory
Investigations for
diagnosis by doctors.
Introduction
A clinical skill may contain
one or several different
domains such as: physical
examination skills, practical
procedure, communication
skills, and management.
Acquiring CSs includes three
components: learning how to
perform certain movements
(procedural knowledge), why
one should do so (underlying
basic science knowledge),
and what the findings might
mean (clinical reasoning).[1]
With the advancement of
laboratory tests for greater
accuracy, there is a tendency
for some clinicians and
students to rely more on
laboratory Investigation and
less on the history of the
illness, the examination and
behaviour of the patient, and
clinical judgment. While in
many cases laboratory
findings are invaluable for
reaching correct conclusions,
the student should never be
allowed to forget that it takes
a man, not a machine, to
understand a man[2]. Multiple

factors in the wrong '

diagnosis leading to
increased fatality and
traumatic events include;
misinterpretations of
laboratory reports ,missing
critical information during
history taking, flawed critical
information, misidentification
of the problem faced by the
patient and typographic
errors.[3]
Advancement of medicine
depends upon the mixture of
clinical skills and modern
equipment. New
investigative methods
improve clinical ability and
perfection of diagnosis, but
doctors must know how to
diagnose by their clinical
skills and instruments.
Excessive reliability on
values obtained by machines
can be dangerous to patient.
Although medical machinery
and measuring devices
increases the capacity of the
doctors but still they do not
replace their art of diagnosis.
[4]
Physicians acknowledge
the poor discrimination of
individual history and
physical examination
findings but often neglect to
consider the true sensitivity
and specificity of imaging
and other tests.[5] [6] Errors
related to delayed or missed

diagnoses are a frequent and

underappreciated cause of
patient injury. Clinicians are
justifiably reluctant, and
often defensive, about
judging their-own or
colleagues' potentially
missed or delayed
diagnoses. A survey was
done in United States to
assess diagnostic errors, 583
cases were examined of
which errors occurred most
frequently in testing phase
(failure to order, report and
follow up laboratory results)
with a majority of 44%.[7]
In certain cases, such as
postpartum haemorrhage
doctors should be efficient
enough in their observing
skills to estimate the blood
loss which can be fatal and
the diagnosis is solely based
on their training and use of
personal skills. [8] Doctors
dependent on the laboratory
findings prescribe frequent
tests and in most of the
cases the tests are repeated
which significantly affects
the cost of treatment and
burden on the patient. [9]Over
the past few decades there
has been an extensive
increase in the medical
technology and due to which
the medical school
curriculums are being

designed to emphasis on the

technology rather than
teaching bedside skills. [10]
During our literature search
we did not find any work that
clearly associates the
dependency of doctors on
investigations for
diagnosis.However
researchsuggest that
laboratory findings are not
always reliable but are
frequently used world-wide
for diagnosis leading to
greater chances of errors and
increased expenditure in
terms of time and money.
Our objective is to assess the
knowledge and practices of
doctors and their
dependency on
investigations for diagnosis.
References
1) Michels MEJ et al. What is a
clinical skill? Searching for order
in chaos through a modified
Delphi process. 2012;34(8):57381
2) Allen, RB. Medical Education and
the Changing Order. New York:
The Commonwealth Fund; 1946.
3) Ahmed Z et al. Errors in Surgical
Pathology Reports: a Study from a
Major Center in Pakistan. Asian Pac J
Cancer Prev. 2016;17(4):1869-74.
4) J Goodwin. The importance of
clinical skills. BMJ 1995;310:1281

5) Engel, G.L. Are medical schools

neglecting clinical skills?. JAMA.
1976; 236: 86163
6) Bordage, G. Where are the history
and physical?. Can Med Assoc J.
1995; 152: 159598
7) Schiff GD et al. Diagnostic Error in
MedicineAnalysis of 583 PhysicianReported Errors.
JAMA.2009;169(20):1881-87.
8) Kordi M et al. Comparison of the
effect of web-based, simulation-based,
and conventional training on the
accuracy of visual estimation of
postpartum hemorrhage volume on
midwifery students: A randomized
clinical trial. J Educ Health Promot. 2016;
5(22):

9) Rogg JG et al. The frequency and cost

of redundant laboratory testing for
transferred ED
patients. Am J Emerg Med. 2013; 31(7):
112123.

10) Hampton JR. Relative contributions of

history-taking, physical examination, and
laboratory investigation to diagnosis and
management of medical outpatients. Br
Med J. 1975; 2:486