What is laboratory medicine (clinical pathology)?
When your doctor orders a blood or urine test, or takes a biopsy, all you usually know is that the sample goes to some mysterious place ("the lab" or "pathology") and either the same day or a few days later your doctor suddenly has a better idea of what is wrong with you and what to do about it.
The lab, however, is not really all that mysterious a place. Blood, urine and other samples are handled in a way that is somewhat similar to what goes on in your doctor's office.
In fact, although you only meet them when you need very special types of laboratory procedures, there are "laboratory doctors" (known as laboratory medicine physicians or clinical pathologists) who supervise and directly carry out these laboratory tests that are used to diagnose your illness and to determine what is the best treatment for your condition. The sample that gets sent to the lab needs to be examined the same way the doctor examines you in the office.
The laboratory doctor applies techniques to examine the specimen that range from examining the components of the blood or tissue with a microscope to analyzing complicated aspects of the DNA and proteins in the blood with more sophisticated machinery. Some parts of this analysis only require general supervision by the pathologist and are carried out by automated equipment; other parts require the continuous intervention by highly skilled technologists working under the supervision of the pathologist; still other aspects of the analysis require detailed consultation by the pathologist to determine how best to figure out what is causing your symptoms.
Do I ever meet with the clinical pathologist?
Although the clinical pathologist is most often the "doctor's doctor" who communicates directly with your primary physician and not directly to you, there are a number of circumstances where you might meet and be directly examined by the laboratory medicine physician.
Some procedures that are frequently carried out by clinical pathologists, for example, are bone marrow examinations and lymph node aspirations. In addition, all aspects of your care that involve blood transfusions and/or the manipulation of your blood (such as plasmapheresis and stem cell transplantation) are under the supervision of the laboratory medicine physician.
How can I have my laboratory tests handled by Yale?
As with most aspects of your medical care, if you have Medicare, Medicaid or a commercial insurance plan, you and your primary doctor have your choice as to where your laboratory testing is performed and what doctors are involved in interpreting that testing.
If you have a managed care insurance plan, then there may be some restrictions on who can perform your laboratory work; however, the vast majority of managed care plans in Connecticut include Yale New Haven Hospital laboratories and Yale Medicine doctors.
Even if you have a plan that has designated a primary "exclusive" commercial laboratory for your laboratory work (for example, Quest Diagnostics or Smith-Kline), the exclusivity usually refers to the exclusion of other major commercial laboratories. Hospital laboratories, such as Yale New Haven Hospital, are frequently permitted to perform your laboratory work.