Great, you have finally managed to develop that in-house multiplex PCR to diagnose disease Y, and thus you can provide the clinicians with a “real-time” result on the same day. Previously you had to send the sample off to a “reference lab”, and a result was not forthcoming for what seemed like an age…

Even better, your in-house PCR has primers for an increased number of target pathogens, thus increasing its clinical usefulness.

And best of all, its cheaper than the price of the Reference Lab equivalent!

Perfect?

Hold on a minute.

The problem with tests that are better or faster than their predecessors is that they are almost inevitably more popular. You may end up with twice the amount of requests than before, obviating any cost savings per individual test. You may also find the requests becoming increasingly dubious in their validity.

I have seen this happen in practice and it is something that microbiology managers and funders need to be very wary of.

How to counteract it? The obvious way is to place appropriate restrictions on test requesting. This can either be by insisting on certain clinical conditions being met, or requiring “authorisation” from an expert in the condition before the test request is approved.

As the range, speed and quality of microbiology testing improves, I suspect that you are going to see more and more algorhythms, guidelines and evidence based restrictions around test requesting. Indeed I see this as being one of the primary roles of a Clinical/Medical Microbiologist.

and that is the way it should be….

Michael