Physicians continue to be master of the game in the Medical profession, where the patients depend on the advice of the

clinicians for many good and bad reasons. However Clinicians play a pivotal role in patient education and in cooperation with all diagnostic services, clinicians may regard quality management of diagnostic services as a matter that is separate from their own area of responsibility. Therefore they are not aware of the need for, and may fail to add, sufficient information on a patient, which makes it difficult for a diagnostic service to provide clinically relevant results. Clinicians may feel that they do not have the time for such activities, and they may not see the clinical outcomes are in fact tied to the diagnostic processes being followed. If I am right around 50% of the Microbiology specimens arrive in the laboratory without minimal clinical information, Take the example of Urine for culture majority of the specimens do not contain any information whether the patient was on catheter, or on Antibiotic Therapy, which will really makes a great difference in reporting for clinician benefit of urine culturing. Clinicians are rarely used for team-work and may feel uncomfortable working as a member of a team of health workers with different professional training or fewer credentials. The diagnostic services may not recognize the clinical importance of its observations in the management of a patient; and vice versa, the clinician may not be sufficiently aware of the relevance of a diagnostic observation to the clinical situation of a patient. It was my early years when I was just a resident in a well-equipped Superspecalists hospital in Andhra Pradesh, our Medical Director a Cardio thoracic surgeon, and a tough administrator, when I introduced myself, he said so you are Microbiologist you examine Our urine and sputum. I felt surprised to find this is the imagination of senior people in the Medical profession, about the benefits of Diagnostic Microbiology; however my sincerity and knowledge proved I can do many things beyond his imagination in Microbiology. The major observations of World Health Organization Studies in developed countries have revealed between 20% and 60%of orders for laboratory investigations are clinically unjustified. With privatization of Medical sector in India, the private laboratories are used as tools to generate money to the Hospitals and to the pockets of busy clinical Practitioners. The clinicians if they write several investigations in the changing world with restrains of the money, definitely patient will realises that he knows little himself in clinical medicine, and wish to investigate him like a Guinea pig. However the one should realise, Patients seek medical help for determination and treatment of various health problems. Sometimes a combination of the patients history and a clinical examination by a primary level physician are enough to decide whether medical treatment is needed, and what treatment should be given. However, often laboratory investigations or diagnostic imaging, or Microbiology culture procedures are required to confirm a clinically suspected diagnosis or to obtain more accurate information. The Young doctors should realise the request to laboratory investigations should be with sense, should take into consideration, the clinical symptoms together with the medical history and physical examination of the patient guide the clinician to request a diagnostic investigation for confirmation or exclusion of a disease. However all Doctors should be familiar with Diagnostic investigation as there are three phases in the process of diagnostic investigation :the pre-analytical phase the analytical phase

the post-analytical phase. The pre-analytical phase comprises the time and all processes for the Preparation of a patient for a diagnostic investigation to the moment when the investigation is made. Please do remember the value of Bacteriological culture reporting is lost in collection of the specimen, when the collecting staff does not know the difference between sputum and saliva in sending the sputum for culture .The analytical phase comprises the time and all processes of a diagnostic investigation. The post-analytical phase comprises the time and all processes for reporting the results of the diagnostic investigation to the person who then undertakes the medical management of the patient. Errors made during each phase influence the clinical relevance of a diagnostic report, and precautions must be taken to avoid results that are misleading or provide false information. The analytical phase is under the supervision of laboratory personal, Surveys in the clinical health services of developed countries revealed that 93% of errors identified are made during the pre-analytical and post-analytical phases, whereas only 7% of errors originate during the analytical phase, provided the diagnostic service has established an effective system for internal quality control. It was also observed that in an ambulatory general medical examination less than 5% of the most common laboratory tests contributed to a new diagnosis and 0.7% to 16% to a new therapy. The diagnostic service must familiarize the clinician with the value of the information obtained from an investigation, including its diagnostic specificity. This requires constant communication between clinical staff and the diagnostic service. Diagnostic reports are valuable only when the information can be used for patient management. It is therefore an obligation for the diagnostic service to provide the results to the clinician in a timely manner so that the results can be interpreted together with the clinical findings for the patient. If the findings do not fit with the patients clinical picture, the clinician should discuss the problem with the laboratory and/or diagnostic imaging staff to find a reasonable explanation. Sometimes it may be useful for an experienced clinician to visit the diagnostic service to confirm the diagnosis of the disease himself. One of the Good hospitals I worked continues to be Apollo Hospitals, Chennai in early 90s under our Laboratory Director Late Dr.CSV Subramaniyam a doyen in pathology, who was consulted by most consultants when in crisis. I always tell many friends I learnt what laboratory means to life and better facts on Laboratory Management from my Guru Late Dr.CSV Subramaniyam. It has been proven that the communication between clinicians and diagnostic services of a hospital is most effective if daily consultations are held to discuss patient s clinical problems and observations made. Clinicians should remember that Laboratories are tools for effective management of patients, and not the place for fishing in the troubled waters. (Ref; Good clinical diagnostic practice WHO information) Dr.T.V.Rao MD Professor of Microbiology, Freelance writer