The clinical pathologist as consultant.

The dictionary defines a consultant as " one who gives professional advice or services; expert. " 1 More than most medical specialists, the role of a clinical pathologist can be heterogeneous: overseeing laboratory testing processes; hands-on patient care, especially in transfusion medicine and hemostasis; performing traditional microscopic pathology; developing algorithms for optimized testing and diagnosis; or some unique combination of these functions. One pathway that unites all clinical pathologists is that they are consultants in the process of testing that provides more than three quarters of the data used for clinical decision making. 2 It is customary to divide the testing process into preana-lytic, analytic, and postanalytic phases. 3 The second component is traditionally considered the domain of clinical pathologists. The laboratory technical staff and activities within the laboratory are clearly paramount to ensure quality patient care. 4 However, the first and third components of testing are just as squarely in the purview of clinical pathologists as they are for the health care providers who order laboratory testing and receive the results. In the preanalytic phase, the primary physician poses a clinical question and selects a laboratory assay to answer it, but it is the clinical pathologist who must build and validate the assay such that there is clinical value to its answer. Moreover, all of the variable details inherent to the preanalytic phase must be accounted for by the clinical pathologist. The complexity of the preanalytic phase is well illustrated by the myriad of genetic abnormalities that, during the past 3 decades, have been linked to clinical conditions. As molecular diagnostic testing has increased exponentially, it has become more difficult for primary physicians to keep pace with the indications for and interpretations of such tests. Moreover, modern physicians are faced with a large number of test options, thereby increasing the risk of an erroneous or unnecessary test selection that may lead to a delay in diagnosis and additional overall costs. Thus, the need for expert consultation with a clinical pathologist before selecting laboratory tests may be critical to enhancing the efficiency of patient care. The responsibilities of clinical pathologists further extend into the postanalytic phase of the testing process to assist primary physicians in reviewing the results and, oftentimes, making an interpretation and/or recommending a future course of action. Because physicians may be unsure as to how to explain test results, they run the risk of inadequate follow-up actions, …