Diagnostic Dilemma: A Clinical Laboratory Poem

I have always believed that laboratory medicine is the foundation of medicine. Another way to say that is, laboratory medicine is the science that underpins medicine. When a clinician orders laboratory tests, in essence they are asking the laboratory to help them take care of their patient. The laboratory touches more patients per day than any other specialty. A busy physician sees between 15 and 25 patients per day, but a busy clinical laboratory provides results for more than 1000 patients per day. Laboratory test results are needed across the entire continuum of health care; including the prevention, diagnosis, treatment, and monitoring of disease. Up to 85 percent of all medical decisions are based on laboratory results. I have written a poem to illustrate the central role that the clinical laboratory plays in diagnosis.

The patient is lying sick in bed

The history we have not read

Nor laid a hand upon his head

Whatever shall we do?

First we’ll order lots of tests.

STAT twenty four- seven to give it our best

We’ll start with CBC, LFT and BMP

How about hepatitis viruses A, B & C?

Golly gee, let’s not forget twice daily Diffs and CMPs

And if the results don’t quite agree

We’ll blame the lab’s accuracy!

Forget the mounting medical fee!

We’ll start again with fiendish glee

And order them all repeatedly

We’ll culture urine, blood and stool.

Measure a lactate and the microbiome gene pool.

Oops! Our patient is looking pale

Why does he appear so frail?

Have we made him iatrogenically anemic?

Time to call blood bank for a hematinic

And if the patient shakes, gasps and cries

A transfusion reaction workup would be wise

To top off our diagnostic plan

Have radiology run a total body scan

Then, to make our diagnosis more secure

A whole genome sequence we will procure

Now everyone can be rest assured

Our patient will be broke but completely cured