Patient-specific Narrative Interpretations of Complex Clinical Laboratory Evaluations: Who Is Competent to Provide Them?

The report To Err Is Human , by the Institute of Medicine (1), has sparked much interest in establishing clinical error rates. The data in the report are focused primarily on medication errors, anesthesia errors, and other procedural errors. Errors associated with establishing the diagnosis, however, received little consideration. One reason is that diagnoses are often established by laboratory test results, and it is difficult to identify errors in test selection and misinterpretation of test results. There is now a spoken need for a change in the current system to provide physicians with assistance in selection of the correct assays and to provide patient-specific interpretations of complex test results to make a clinical decision (2)(3)(4).The report by Lim et al. (5) in this issue of the Journal describes a quality assessment of interpretive commenting in clinical chemistry. Previous reports have described the interpretive process and noted the value of the service (6)(7)(8), but this study evaluates the performance of potential interpreters for the service process. The interpretations in the study by Lim et al. (5) were generated by pathologists or senior scientists and “any other interested laboratory personnel”. The data in this report demonstrate the need for highly knowledgeable individuals, most likely within individual subspecialties of clinical chemistry (e.g., toxicology, endocrinology, and tumor markers), to interpret complex clinical laboratory evaluations. The authors found (as judged by a panel of experts) that interpretation errors in many of their test cases occurred as …