I believe there are three reasons for clinical details to be provided with a request;

Firstly, so the right test can be performed; For example, a request for hepatitis serology may be in the setting of acute hepatitis diagnosis, chronic hepatitis monitoring or hepatitis B vaccination - and the laboratory need to know in order to perform the right test.

Secondly, it is important to know the clinical setting so that the laboratory can be involved in interpretation. The ability to interpret results varies between clinicians (who know about the patient but may not know the nuances of analysis) and laboratory specialist (who knows the nuances of analysis but is rarely fully informed about the patient). Ideally patients should benefit from the knowledge of both clinical and laboratory specialists. This can be critical; If a glucose level is very high, is the patient a known diabetic or was the sample taken from a patient on a dextrose drip? Or, for example, is the sample from a child with unknown diabetes who may develop diabetic keto-acidosis overnight? Ideally any request which could come back critically abnormal, needs clinical notes to manage the potential risks in interpretation.

Thirdly, in many settings, requests for expensive testing need to be justified in order to preserve the precious health dollar. This does not necessarily imply a clinical barrier to access, as it could be represented as clinical decision support for requesting where clinicians are guided, by an agreed clinical consensus, through an algorithm which justifies testing.

In general clinicians fill in lab request forms without giving clinical details. This is suitable for very basic requests like sodium, glucose, TSH, ESR or Hb if it is only for control purpose or as a check up.

However for more specific diagnostic workup it would be wise to include clinical details, for example previous conclusions or a specific diagnostic question. For general physians a specific request form with e.g. the 20 most frequently met diagnostic questions (like anemia, liver disease, high blood pressure, etc) is used in the Netherlands. This GP request form is contructed by physicians and laboratory specialists together and based on present guidelines for those diagnotic questions.

For very specific analysis, like a workup for suspected inherited metabolic disease, bone marrow analysis, endocrinology questions, either the clinician should be a specialist (knowing the details of the test program of the lab and the tests needed for his patient) or the clinician should contact the lab to discuss the diagnostic path and the tests needed and available.

Hence, there is no general answer to your question. Labs hate it to be regarded as only a test delivering factory.

Also the ISO guidelines for medical laboratories advocate the mutual contact between lab and clinician for the benefit of the patient.

I support Dr. Wielders. Advocacy needs between clinicians and lab managers for the special cases.

I believe there are three reasons for clinical details to be provided with a request;

Firstly, so the right test can be performed; For example, a request for hepatitis serology may be in the setting of acute hepatitis diagnosis, chronic hepatitis monitoring or hepatitis B vaccination - and the laboratory need to know in order to perform the right test.

Secondly, it is important to know the clinical setting so that the laboratory can be involved in interpretation. The ability to interpret results varies between clinicians (who know about the patient but may not know the nuances of analysis) and laboratory specialist (who knows the nuances of analysis but is rarely fully informed about the patient). Ideally patients should benefit from the knowledge of both clinical and laboratory specialists. This can be critical; If a glucose level is very high, is the patient a known diabetic or was the sample taken from a patient on a dextrose drip? Or, for example, is the sample from a child with unknown diabetes who may develop diabetic keto-acidosis overnight? Ideally any request which could come back critically abnormal, needs clinical notes to manage the potential risks in interpretation.

Thirdly, in many settings, requests for expensive testing need to be justified in order to preserve the precious health dollar. This does not necessarily imply a clinical barrier to access, as it could be represented as clinical decision support for requesting where clinicians are guided, by an agreed clinical consensus, through an algorithm which justifies testing.

Ideally, all test requests should accompany a clinical case history and other relevant information about the patient. But usually, for the routine tests, a writing detailed history with every prescription is not practicable, specially in hospitals, where the amount of workload is too huge. But for more specific diagnostic tests like tumor markers, hormones, cytokines etc. or for samples for eletrophoresis etc, a relevant past and present clinical history along with history of medication should be provided with the test request, which will help the laboratory experts to interpret the results accordingly and take any necessary modification in the analysis and interpretation.

Nowadays, many hospitals are adopting a Hospital Information System (HIS), where each patient is being assigned a registration number during admission and henceforth every clinical history, test results, medications, interventions or procedural history is getting recorded in the central server against that specific registration number. And henceforth, every healthcare expert of that institute, involved with the treatment of that patient, can access the information against his/her registration number from the HIS server, and accordingly interpret or intervene. A wider use of HIS, hopefully will solve this dispute about how much information must be provided in test requests, and how much is practically possible to provide every time.

Blind tests is better. Do not give the lab any details, give them just sample. Let them test the sample without any bias.

Bests

I'm sorry Hussein, I do not agree with you.

The lab and its professional head is cooperating with the physician and they are not an opponent that could be biased, because they know the background of the request.