A word about labs…..

Gone_With_The_Wind_1967_re-releaseLabs are an amazing tool.  They have added so much to our understanding of the body and our ability to diagnose many problems and manage a great number of conditions more effectively. It’s difficult to imagine how we could manage some things without them.

However…

There have been over the years some unintended consequences to their use.

First and foremost.  It is very easy for clinicians to focus on labs more than they may on a patient.  I can look back at times when I’ve been guilty of that myself.

But I think it behooves us to remember a couple of things about labs.

One, lab values have ranges, and what is called “normal” is in reality, somewhat arbitrary.  Many ranges are done by testing a group of people, ASSUMING that those people are “normal” and developing a normal curve for anything you want to measure, chopping off 2.5% on the top and bottom and calling the rest “normal.”  Well, if the group you’re checking isn’t normal, your labs won’t be either.  Further, normal does not mean optimal or functional.  That has to be ascertained by melding the information from a lab, with the information from a history and physical from the patient.

But, it’s easy for providers to slip into relying a lot on labs.  Labs don’t argue back.  They don’t have nuance (or so they think).  They don’t have perspective.  And therefore, they CAN NOT give the total picture.

Even more important to realize I think, is that a lab only tells you what is happening at ONE POINT IN TIME.  It, perhaps, says nothing about what is happening at other times, and we always ASSUME that what we see represents our patients all the time.  Which certainly isn’t always the case, and maybe the case even less than we think.

It’s a bit like believing one could fully get Gone With The Wind by seeing a screen shot of Rhett and Scarlett kissing.  You can understand that these were people who were deeply involved with each other, but you get only a small glimpse into the story and history between them.  Thus it is with labs. We can know what we check at one point in time, but we know nothing about the other characters we don’t check on, nor do we know what the ones we’re looking at are at other points in time.  Your body and your life are the “screen” that the movie of your life is played out on, and that is only seen when a practitioner takes the time to know the story of what is happening with you as he or she considers your labs.

Just something to remember….

JMA