UNDER THE MICROSCOPE

As a pathologist and laboratory science practitioner, I am  often approached by friends, relatives and even recent acquaintances about their laboratory results. But even though I know laboratory science, it doesn’t mean I’m in the best position to interpret and explain these.

When we came back home from training abroad, I was shocked to hear doctors who would call the lab complaining that their patients were not allowed to get the results themselves, and contending  that these patients had paid to get their results. When I was the head of a laboratory, I instituted a regulation that results should be sent to the doctors’ clinics where the patient could learn the results from their doctors within the context of their specific cases. This is the case in other countries and makes more sense than allowing patients to have the first look at their results.

To back up a little, let us explore the nature of laboratory testing. A request for laboratory testing is usually issued by the attending physician of a patient. This is based on the results of the history and physical examination of the patient wherein the doctor formulates his/her diagnosis, or in the event the findings are inconclusive, differential diagnoses. These are a group of diagnoses that might explain the patient’s signs and symptoms. To differentiate these diagnoses, laboratory and/or imaging (x-rays, ultrasound, CT scan, MRI)  tests are requested.

Therefore, laboratory tests are necessary to establish or confirm a diagnosis since medical dictum states that if a single disease entity can account for all or most of the findings in a patient, that is most likely to be the correct one.

So, if this is the case, then the attending physician is the best and the most capable person to interpret and explain laboratory results to the patient. In fact, having ordered the tests, he/she is   responsible for doing so. Some results are so straight forward that even lay persons can understand them. However, there are certain nuances that are not appreciated by non-medical persons. 

Certainly, a battery of test results can be bewildering for the patient. All these have to be reviewed by the doctor who ordered the tests and must be correlated with the clinical history, signs and symptoms and physical and imaging findings to come up with the correct diagnosis/ diagnoses. Sometimes, patients may have coexisting diseases that may confuse even the most astute doctors. Hence other medical specialists may have to be called in to confer with the attending physician. In the more complicated cases, a family conference may be called, with the attendance of several medical specialists and subspecialists.

The practice of modern medicine has evolved with the rise of subspecialties. These are areas of a particular medical specialty (internal medicine, pediatrics, surgery, OB-GYN) that have branched off to focus on particular aspects of the human body (cardiology, pulmonology, gastroenterology) or even into more detailed aspects such as electrophysiology of the heart, movement disorders in neurology and many others.

These subspecialists may order more esoteric tests whose results will certainly not be entirely comprehensible to regular doctors or other specialists. So, it is even more important that these test results be reviewed by them.

But wait, you say. My doctor just ordered simple laboratory tests. So, I had the tests done and I paid for them. Don’t I have the right to get the results for myself?

Well, yes, you did pay for the tests your doctor ordered. But are you in the best position to view the results without your doctor interpreting them for you? No. 

It can be dangerous for patients to get their results directly from the laboratory and read these for themselves. Without the proper context, lab results can be bewildering, frightening or depressing for some patients who are already stressed by their medical condition. This is particularly true of histopathology/biopsy results that show cancers or other serious condition. There have been anecdotal reports of patients, who upon receiving their lab reports with a cancer diagnosis, committed suicide. 

Nowadays, a cancer diagnosis is no longer necessarily a death sentence. Cancer in early stages can be cured. Even more advanced cancers can now be treated with modern drugs that specifically target the cancer cells and leave normal cells unaffected. For these patients, there is no reason to despair.

So, please, dear patients, if you get your lab results personally, don’t try to look at them yourselves. Have your doctor do it for you. It is their prerogative and responsibility to interpret your results based on his/her appreciation of your clinical signs and symptoms and history. It is your right. You deserve better.