“The road to Hell is paved with good intentions” (ancient proverb)

• A laboratory might culture only 50 samples in a year for mycobacteria and look forward to getting a positive culture for Mycobacterium tuberculosis once in a ‘blue moon’.
• A scientist might be happy to report “No microfilariae seen” on a blood sample despite having last seen a positive case of filariasis 25 years ago.
• A clinical microbiologist might be willing to give advice on the significance of a rare filamentous fungus that they have only read about in the textbooks.

If I am doing a lab inspection/accreditation for another microbiology laboratory, one of the first things I do is find out is what tests/procedures are being done in low volume. (the other is to spend as much time as possible with the staff on the benches, to find out what really happens in the lab…)

We all have good intentions, but the cold reality is that if we only encounter something very occasionally, the chances of us getting it wrong are much increased.

Quality and knowing your/the lab’s limitations are necessarily entwined.

There is no shame in referring low volume tests on to another bigger laboratory, nor is there shame in seeking advice about something you don’t encounter very often, from someone who does.

I work in an affluent area of provincial New Zealand. Throw me into a microbiology laboratory in Sub-Saharan Africa and I would absolutely be a fish out of water.

Despite our best intentions, we can end up doing more harm to our patients if we think we are as good at doing the things we only do occasionally, as opposed to the things we do often… 

Michael