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Why clinical chemistry should be a part of medical education

Clinical Biochemistry or chemical pathology laboratory deals with analyses of body fluids for diagnostic and therapeutic purpose. It is applied form of Biochemistry.

The laboratory testing cycle consists of steps starting from the requisition made by the doctor, collection of samples, labeling, analyzing, data collection, data entry into the register and report form, delivery to the physician concerned in time, interpretation, arrival at a proper diagnosis and institution of proper therapy.

The use of clinical laboratory, therefore, helps in taking proper decision and forms a part of clinical medicine.

The menu of laboratory tests available constitutes an impressive array of tests which expands exponentially since the days of its inclusion in the realm of diagnostic medicine. (1920)

In other words, from the days of Folin Wu method of estimating glucose to dry chemistry strip analyses by glucometer, Laboratory medicine has come a long way.

Despite its metamorphosis to automation and robotic testing of samples, the full benefit to the patient emanating from such analyses depends upon a good interaction between the practicing physician, lab consultant, lab technical staff and various departments. Communication need to be reliable, scientific, and in time.

There is a dire need for training lab professionals, standardization of laboratory measurements, quality control following specific operative procedures. (SOPs)

The importance of laboratory exposure to medical undergraduates is diluted. Rather the competency-based curriculum relies more on case histories, OSPE and fewer analytical procedures like urine analyses and glucometer estimation.

The National Medical Council or the governing body of medical education need to include visit to a clinical chemistry laboratory, understanding the basis of quality control, instruments used, the techniques involved and the automated analyzers role in diagnostic medicine.

One of the major objectives in laboratory medicine is selecting the appropriate tests and eliminating unwanted invasive testing of the patient.

A laboratory test selected for a patient may help in

  1. Diagnosis (to rule in or rule out diagnosis)
  2. Monitoring (e.g. effect of a drug or therapy)
  3. Screening
  4. And Research to understand better the pathophysiology of a particular disease.

It is to be observed that there are certain principles that are followed for establishing a diagnosis based on laboratory tests results.

They include:

  • Pattern recognition
  • Medical algorithms
  • Rifle versus shotgun approach.

To keep it short and concise, one has to understand the difference between treating the symptoms and curing the condition. Say for example, a broken wrist really hurts. But painkillers will only take away the symptoms. You need proper treatment to cure the fracture.

Root cause analyses is a popular and often used technique that helps people answer the question of why the problem occurred and determine the cause of its occurrence. Even a puncture shop mechanic finds out where the puncture is before he mends the tyre.

Like the mechanic who uses helium mass spectrometer to detect the leaks, we doctors use clinical chemistry as an important guide for the proper diagnosis of a patient.

Clinical chemistry, being an arm of applicative Biochemistry, which focuses on the methodology and interpretation of chemical tests performed to support diagnosis and treatment, has to be a part of Medical undergraduate education.

by Nandini Neelavanan, Dr D S Sheriff