Much attention has been given to testing this year, so much attention that the subject has become confused and misunderstood by many. What is testing? Who should be tested and when? What kinds of tests are there? What is the meaning of positive and negative results? These and other questions should and do have clear, simple answers. But in the noise that accompanies the pandemic, clarity is lost. The result is widespread and profound misunderstanding of the utility and application of diagnostic testing in our fight against COVID-19, the disease of the pandemic.
A clear understanding of testing is important. Diagnostic excellence is the foundation of excellent treatment outcomes. Clarity of understanding must precede planning and execution. Tragic accidents are more likely in the fog of distorted perceptions. Using my perspective and experience as a clinical pathologist, my only purpose here is to make the use of laboratory testing as clear and understandable as possible.
During the nine years I spent in medical school and pathology training at the UT Southwestern Medical Center at Dallas, I had the good fortune to encounter some of the most renowned researchers and practitioners of my profession, men and women whose mind-power far exceeds my own, but whose common sense approach to solving diagnostic problems had a profound and enduring impact on my career in pathology. Added to the formal education and training, I have spent more than 25 years in practice at a mid-sized community hospital as pathologist and laboratory medical director. My career has driven home fundamental lessons of laboratory medicine: when it is important to test, when it is better not to test, and how misunderstanding of test results can lead well-meaning doctors astray, to the detriment of their patients.
In the blogs that will follow, I will sacrifice scientific rigor for clarity and understandability. I am a practitioner, not a scientist. Accordingly, my emphasis is on the use and pitfalls of diagnostic tools, not the precise science that makes the tools possible. The science is fascinating, and, at a certain level, necessary for the appropriate use of the clinical laboratory. But a rigorous understanding of science is not the same as mastery of use of the diagnostic tools created by science any more than the knowledge of piano construction confers the ability to play. Incidentally, I firmly believe that even our most fundamental scientific theories should never be considered true and unchangeable representations of reality, but rather artificial constructions that make certain phenomena understandable and predictable. However, as I am not a scientist, I am neither a philosopher, so I leave to the philosophers the further contemplation of these compelling yet impractical notions. For now.
