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As the recently appointed Editor-in-Chief of the Journal of the
IFCC, I would like to thank my predecessor, Johan Waldenstr�m both
for the work that he put into the journal and also for arranging
for and preparing some of the articles presented in this issue.
The International Federation of Clinical Chemistry has in recent
times extended its name to become the International Federation of
Clinical Chemistry and Laboratory Medicine. This last phrase not
only confirms the inclusion of haematology and medical microbiology
(and perhaps, in due course, even cellular pathology) but also
re-emphasises the implication made by the word "Clinical" in the
original title by including the word "Medical".
Clinical Chemistry and these associated specialities are, of
course, based upon laboratory analyses and examinations. It is
essential that we have in these professions good scientists, expert
in the preparative, analytical and observational skills upon which
the main function of a laboratory is based. It is important that
the professions continually monitor the methodology used in the
laboratory so that it is the best available and best fulfils the
purpose for which it is being used. It is also important that the
quality of the work being carried out is frequently subjected to
quality control procedures to ensure that accuracy and precision
are as high as possible and errors are eliminated as far as
possible. These should, of course, be the principles upon which all
analytical laboratories are run, be they testing laboratories,
research laboratories, or forensic laboratories, etc..
But members of the associated societies of this international
federation should be more than just good analytical scientists.
They are professionals in the realms of Clinical Chemistry and
Laboratory Medicine. They should therefore, as well as being good
scientists, also have a good insight into the clinical and medical
aspects of their work. We can expect a specialist in one of the
medical or surgical specialities to have a good working knowledge
of the meaning of those laboratory investigations that are central
in their own speciality, and to keep up to date with advances in
these limited fields. Thus a urologist should be able to interpret
a PSA result; an endocrinologist should have a good knowledge of
hormone biochemistry and of the tests required to diagnose and
monitor the treatment of endocrine patients; a cardiologist should
know the benefits and limitations of troponin assays and the
interpretation of a lipid profile. But none of these specialists
can be expected to have good knowledge and keep up to date with the
wide range of biochemical, haematological and microbiological
assays that are carried out in medical laboratories. And
generalists, including those practising medicine in the community,
are also unlikely to be able to keep up to date with the latest
advances in laboratory medicine.
It is the duty of the senior hospital laboratory staff to
educate our clinical colleagues about important developments in our
specialities and to advise and assist them in interpreting the
meaning of the investigations carried out in our laboratories. We
should be trained to understand the meaning of diagnostic results
of tests that we are responsible for carrying out. Within the
professions of laboratory medicine there are, in some countries,
those that have qualified in medicine; in others countries the
laboratory service is run entirely by science graduates; in some
countries there is a mixture of both, and some individuals have
graduated in both science and medicine. But whether medically or
scientifically qualified, all senior graduates in hospital
laboratories should have a good understanding of the clinical
relevance of the tests carried out in their laboratory. In the
United Kingdom, all Clinical Biochemists (members of the
Association of Clinical Biochemistry) are encouraged to study for
the examinations leading to Membership of the Royal College of
Pathologists; they cannot reach the top of their profession without
such membership. These studies and the associated examinations are
taken by both science and medical graduates and include clinical,
analytical and managerial topics. Medical graduates are taught
about analytical matters, science graduates are taught about
clinical matters; both are taught the basis of good laboratory
management practice.
We should all be familiar with these matters and be prepared to
make use of our training and experience not just in the analytical
phase of our work. The importance of the pre-analytical phase has
been widely discussed and written about; the importance of
educating our users in the appropriate tests for the particular
purpose that they have in mind; the importance of proper patient
preparation, of collecting the sample in the right container in an
appropriate way, and of transporting it to the laboratory with
minimal delay and in the right conditions. But we also have an
important role to the patients that we serve in the post-analytical
phase; ensuring that results get properly delivered, electronically
or by post, to the proper destination; highlighting any clinically
significant results and giving advice on their interpretation;
ensuring speedy telephoning of potentially life-threatening
abnormalities; carrying out second-line tests if the first-line
tests indicate it (or advising the requester that such second-line
tests should be undertaken).
We are not just analytical scientists, we are professionals
working in a clinical environment. We should ensure that we are
properly trained and experienced to fulfil our full
commitments.
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