The Laboratory
Medical laboratory data are obtained to aid in diagnosis or to focus treatment. I have maintained, ever since I was teaching medical students and residents at UCSF, that one should only get a lab test if it is going to influence treatment. Curiosity is not good enough, unless the doctor is paying for the test.
That being said, the amount of laboratory data we collect varies enormously, depending on the patient. The reason for the variation? Sometimes, treatment is more obvious than others.
I have a bias in favor of empirical treatment – embarking on a course which seems reasonable given the patient’s history and physical, obtaining just enough lab data to be sure treatment can be given safely, and following at intervals to determine complications are not arising (e.g., liver and kidney function tests). If, however, the patient’s response to treatment is less than expected, other tests might become necessary: genetic tests, to determine if there is a specific mutation undermining treatment, or metabolic tests to determine if there is a defect which can be overcome.
For the convenience of our patients, our office lab maintains several sensitive tests and instruments to provide routine data. For less-routine laboratory testing, we have carefully selected reliable and experienced laboratories to process our patients’ specimens.
We understand that medical care is expensive, and try to keep lab testing to the minimum necessary to deliver safe and effective care.