The future of healthcare delivery systems will depend on their ability
to provide the best care at the least cost. In the clinical laborator
y, this translates to ensuring that decreased test use means appropria
te use. The latter is unlikely to occur unless clinical laboratories p
rovide practicing physicians with advice on test strategy and interpre
tation of results. Effective clinical laboratory consultation requires
an identification with clinical problems. Important components of the
identification process are an appreciation of the probabilistic rathe
r than deterministic nature of the relation of clinical and laboratory
data to disease and the inevitable tradeoff between false negatives a
nd false positives that clinical circumstances demand. Institution of
consultation services requires that the clinical laboratory adopt a pr
oactive approach to advocating test strategy and interpreting results.
Consultation on test strategy is likely to be facilitated by further
developments in practice guidelines and by advances in informatics and
telemedicine.