Laboratory medicine
The Laboratory Medicine ( "Laboratory medicine") is a diagnostic field of medicine at the interface of science subjects such. B. chemistry or molecular biology .
In Germany there is special medical training to become a specialist in laboratory medicine , while the subject in Great Britain is e.g. B. represents the pathologist as "pathologist", in France the biologist as "biologist". As part of the harmonization of the European further training regulations, work is being carried out on standardization, but this should not be easy due to long national traditions with corresponding professional regulations.
Fields of activity
Laboratory doctors are interdisciplinary for almost all medical disciplines, v. a. but active in general medicine and internal medicine . You create laboratory results for the diagnosis and staging of diseases, course therapy control and prevention. In addition to the actual analysis, they organize sample preparation including transport to the laboratory (pre-analysis) and the return of the laboratory results to the requesting doctor, including remote data transmission and advice (post-analysis).
The laboratory work focuses on clinical chemistry and immunochemistry , hematology (disorders of the blood) and hemostaseology (disorders of blood coagulation), microbiology and infection serology , transfusion medicine and human genetics . Some of these disciplines have their own specialist or additional qualifications as well as scientific certificates (e.g. clinical chemist). In addition to the serological infection diagnostics , which only concern a few pathogens , which are partly carried out for logistical reasons within the framework of clinical chemistry, there is also the specialized bacterial and parasite diagnostics and virus diagnostics with a special specialist medical qualification.
Specialist in laboratory medicine
In order to work as a specialist in laboratory medicine after completing a medical degree in Germany , a five-year further training period is required:
- 1 year in internal medicine and general medicine (acute hospital) or pediatrics
- 4 years of laboratory medicine, of which
- 1/2 year in a microbiological ,
- 1/2 year in an infection serological and
- 1/2 year in an immunohematology laboratory.
- Can be counted towards laboratory medicine
- 1 year in microbiology, virology and infection epidemiology
- 1/2 year in transfusion medicine
Three years can be served with a resident doctor.
Normally, a patient hardly ever comes into personal contact with the laboratory doctor, unless it is necessary to take blood samples and obtain other examination materials such as B. bone marrow , cerebral and synovial fluids , semen and stool . However, laboratory doctors often offer training and advice, e.g. B. in the context of blood sugar self-testing , human genetics or preventive medicine .
National
Germany
- On January 1, 2001, 1,223 specialists for laboratory medicine were registered in Germany , of which 466 were resident. 324 did not practice any medical activity.
- Laboratory medicine in Germany has also been subject to the approval ban in the context of statutory health insurance requirements planning since 2013.
Only 160 of more than 2000 hospital laboratories are managed by laboratory doctors (as of 2005). The others are usually subordinate to a specialist in internal medicine, on whose behalf a clinical chemist (natural scientist with appropriate training) and medical-technical assistants work. Established laboratory practices, on the other hand, always have to be managed by a specialist in laboratory medicine.
As in other specialist areas, the number of laboratory doctors is currently decreasing due to the aging of the population and the shortage of young people in medicine.
Methods
The important tests in laboratory medicine include blood tests , urine tests and other tests, for example cytodiagnostics of the sputum .
Normal ranges
Normal ranges are typically assessed on a large number of apparently healthy individuals. The so-called normal values are given as the upper and lower limits of the range in which 95% of all measured values are located. A value outside the normal range does not automatically mean that the person in question is sick, on the contrary: every 20th value must, by definition, be outside the specified limits for healthy people.
The normal ranges depend heavily on the methodology used, the population studied, etc. Limit values are listed under blood tests and urine tests . Due to the many influencing factors, these are only to be understood as reference values. For the evaluation of laboratory results, the specific table of the respective doctor is valid and in case of doubt a personal medical interpretation is required.
Reference ranges and decision limits
Conversely, all normal ranges overlap to a greater or lesser extent with the values that are obtained for patients. Your measured values depend e.g. B. on the type, stage, severity and treatment of the respective disease: The level of the tumor marker PSA z. B. definitely something about the overall size of the prostate, but next to nothing about the benign or malignant causes of a possible enlargement. In order to achieve an optimal separation between healthy and sick people, special reference ranges and decision limits are required for each medical question.
Reference values
Please refer:
literature
- Norbert Henning (Hrsg.): Clinical laboratory diagnostics. Urban & Schwarzenberg, Munich / Berlin / Vienna 1958; 3rd edition, ibid. 1966, ISBN 3-541-01053-3 .
