4 CHAPTER 1 Overview of the Clinician’s Role

TABLE 1.1, continued

Diagnostic Test Indication

Computed tomography (CT)
scans
DNA testing of hair, blood, skin
tissue, or semen samples
Other genetic tests
Before and after treatment for certain cancers, injuries, illness
(e.g., suspected transient ischemic attack, cerebrovascular
accident; diagnostic evaluation of certain signs and symptoms)
Gather postmortem evidence, in certain criminal cases;
establish identity and parentage
Assist in establishing or ruling out familial inheritable diseases

Some tests are mandated by government agencies (e.g., U.S. Preventive Services Task Force) or clinical practice guidelines of professional
societies (e.g., American Congress of Obstetricians and Gynecologists); others are deemed part of necessary care based on the individual
practitioner’s judgment and expertise, primary clinician, or a group practitioner consensus. There is not a consensus as to the frequency of
testing (e.g., annually or after a certain age). Some will commonly be ordered at point of care.

care and an understanding of psychoneuroimmunology (effects of stress on health status), make careful
judgments, and gather vital information about the patient and the testing process to diagnose appropri-
ately within the parameters of the clinician’s professional standards (Table 1.2; Chart 1.2).
The diagnostic testing model incorporates three phases: pretest, intratest, and posttest (Fig. 1.1).

N OT E Laboratory terminology uses the terms preanalytical, analytical, and postanalytical.

The clinical team actively interacts with the patient and his or her significant others throughout each
phase. The following components are included with each laboratory test or diagnostic procedure in this text:

Pretest Interventions:
1. Test background information
2. Reference (normal) values
3. Explanation of test
4. Indications for testing
5. Signs, symptoms, and history of disease

Intratest Interventions:
1. Actual description of procedures
2. Proper specimen collection and transport

CHART 1.1 Grading Guidelines for Scientific Evidence

Grade Guideline Example

A Clear evidence from all appropriately Measure plasma glucose through an
conducted trials accredited lab to diagnose or screen for
diabetes
B Supportive evidence from well- Draw fasting blood plasma specimens
conducted studies or registries for glucose analysis
C No published evidence; or only case, Self-monitoring of blood glucose may
observational, or historical evidence help to achieve better control
E Expert consensus or clinical Measure ketones in urine or blood to
experience or Internet polls monitor and diagnose diabetic
ketoacidosis (DKA) (in home or clinic).