Prior to the 20th century, physicians themselves performed a small set of "lab tests" for their patients. One such example was tasting urine which was sweeter for diabetic patients (see: Urine flavor wheels helped doctors taste patients' pee centuries ago). Bedside diagnostic skills in these earlier days were more highly developed than today. Physicians of earlier generations thus performed all diagnostic and therapeutic functions for patients. This began to change in about the mid-20th century as the lab test menu expanded greatly and the sophistication of radiologic procedures increased. Commensurate with this shift, physicians' bedside diagnostic skills began to atrophy. Physicians caring for patients, of course, control all final diagnostic decisions and dictate all therapeutic interventions. However, what I will call the "lab/rad" contribution to final diagnoses is currently very large and will continue to increase.
Regarding the lab/rad contribution to final diagnoses and considering clinical pathology (CP), diagnoses are generally not rendered but rather key test results are reported that lead to final diagnoses. For anatomic pathology (AP), pathologists have always rendered precise diagnoses. Radiologists report "impressions" which continue to be more precise and, in many cases, actually constitute diagnoses. We are now on the verge of the rendering of definitive diagnoses in CP with increasing sophistication in molecular and genomic diagnostics. This trend will continue with increased diagnostic acumen of pathologists and radiologists driven by AI and deep learning. Add to this mix the increasing sophistication of wearable health ecosystems (see: The Evolution of "Wearable Health Ecosystems" and Associated Partnerships) such that healthcare consumers themselves now can generate increasingly sophisticated health data from home.
The conclusion from all of this is that physician-clinicians will continue to bear responsibility for making the final diagnoses for their patients after receiving and integrating critical reports form multiple diagnostic sources including lab/rad and, soon, connected home health (see: Connected health). This should not be construed as a problem but rather as an advancement in healthcare driven by science and technology. The downside of this trend is the increasing fragmentation and silo-ization of healthcare (see: The Antidote to Fragmented Health Care). Information technology can enable system interoperability and the merging of health records but this is a non-trivial challenge.
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