019 - Laboratory Medicine and improving care: essential service, interdisciplinary perspective, olistic vision
Autor(s): Piero Cappelletti
Issue: RIMeL - IJLaM, Vol. 3, N. 3-S1, 2007 (MAF Servizi srl ed.)
Page(s): 19-24
Although the laboratory represents a small percentage of health care costs, it leverages 60-70% of all critical decisions, e.g., admission, discharge, and drug therapy. The various ways diagnostics influence patient care, which extend well beyond diagnosing disease, include assessing disease risk sooner; detecting and diagnosing disease earlier, faster, and more accurately than ever before; selecting more targeted, effective, and often less invasive treatments; closely estimating patient prognosis; and, managing chronic disease effectively. With the potential to fundamentally alter clinical practice, laboratory technologies are intended to match the “right patient with the right treatment at the right time” and the scientific breakthroughs, such as the development of molecular diagnostic tests, are driving the movement toward personalized medicine. Moreover an expanding body of evidence-based clinical practice guidelines substantiated the critical role of diagnostics in health care decision-making. From a conceptual standpoint, the essence of Laboratory Medicine is to answer to the implicit or expressed clinical question. In this framework, the key is the clinic-laboratory interface, where the essential activities of Laboratory Medicine such as materials and information exchange occur. To answer to its own nature, Laboratory Medicine should maintain the governance of the total testing process. In the Laboratory without walls the focus is not only the analytical affordability but also the outcome quality, for the individual patient and for the clinical world and society. The latter laboratory activities occur within multidisciplinary groups for searching and implementing evidences about diagnostic procedures, treatments, and care maps. Moreover, today Laboratory Medicine meets Health Technology Assessment, defined as a method for examining medical, societal, economic, and ethical aspects of the adoption and use of health care technology, and therefore as a comprehensive form of research examining the long-term and short-term consequences of technology application with regard to the health of patients. The interdisciplinary perspective focuses the difficult issue of the equilibrium among specialty skills and global vision about the discipline, among the rule of success “become Mr. or Madam Something” and the definition of Laboratory Medicine as “an expansive discipline that is anchored in the clinical laboratory and encompasses a fund of knowledge, reasoning, and skills in pathophysiology, diagnostics, and therapeutic”. The more recent proposals about the competencies required by laboratory consultants to address current challenge include not only the perfect knowledge of technical and scientific work but also the need to give comprehensive consultative support and emphasize the evolution of clinical laboratories into knowledge services. From this point of view, Laboratory Medicine maintains, together to General Medicine and perhaps Internal Medicine, a potential olistic vision of itself and of its relationships with the Patient.