The clinical importance of laboratory reasoning

The radical changes made in the delivery of modern health care have serious implications for laboratory services, because reasoning in laboratory medi cine should follow a clinical rather than a technological logic. Appropriat e test requesting and interpretation coupled with a patient-oriented vision improve the outcomes for patients, and so ensure the best cost containment strategy. The fact that analytical operations are standardized and quality controlled, may lead to a greater recognition of the importance of pre- an d post-analytical issues. Particularly critical aspects are the formulation of the clinical question and the interpretation of laboratory results. Lab oratory-clinic communication is fundamental in achieving and maintaining to tal quality in laboratory services. Effective consultancy stands or falls w ith the knowledge and experience of laboratorians, as well as continuous ed ucation is required to maintain the best utilization of laboratory informat ion in clinical decision-making. As clinical audit is an important tool for reviewing and improving the quality of the service in clinical laboratorie s, it should make up an important part of programs for accreditation and qu ality improvement. If a patient-centered vision predominates, the clinical laboratory will be linked to both physicians and patients, making it more t angible to the latter. (C) 1999 Elsevier Science B.V. All rights reserved.