Laboratory medicine: the need for a broader view the "multiple bundle" model of clinical laboratory function.

The essence of the nineties in health care, in business, in organizational management and in education, has been change. As always in a changing environment, there will be winners and losers. In the September issue of CCLM, Williamson wrote: "Poor clinical chemistry. It is a field trapped between pressures from increasing electronic automation of assays, simplified technology and reductionism of molecular genetics and the growing pressure of economic accountability and cost cutting. It may not survive" (1). Should we all be on Prozac and wait for the doomsday? Our problems are not unique. Some time ago, traditional cardiology was "trapped" between the advent of new invasive techniques on the one hand and a pressure to increase emphasis on prevention on the other. How did it end? Most of today's cardiologists are invasive cardiologists and many became leaders in cardiovascular prevention in addition to their "traditional" tasks (2). This is a classical example of a paradigm shift. The present article suggests that at least some of our problems may stem from too narrow a view of laboratory medicine that we present to decision makers who allocate funds to laboratory services.