From laboratory instrumentation to physician’s brain calibration: the next frontier for improving diagnostic accuracy?

Giuseppe Lippi, Gianfranco Cervellin


Instrument calibration is a common practice in laboratory medicine aimed to translating electronic or optical signals into clinically usable concentrations for many analytes. Although much technological advancements have contributed to make the analytical process a much safer enterprise, the risk of analytical errors, including the use of unacceptable analytical calibrations, has not been completely voided. There are many weapons that we can use to lower the risk of overlooking calibration errors in laboratory medicine, such as the use of standard operating procedures (SOPs), internal quality controls (IQCs) and automatic inactivation of analyzer functioning in case of IQC failure. Unlike instrument calibration, the clinical decision making strongly relies on cognitive skills, and involves innate ability, expertise and even luck. As for many other human activities, training of healthcare staff and optimization of clinical interpretation through a process of “physicians’ calibration” are effective to lower the risk of medical and diagnostic errors. Physicians’ calibration can hence be defined as a set of activities aimed to define, under specified clinical conditions, the correlation between specific signals (signs and symptoms) present in a given patient and the likelihood of a certain pathology, so aligning the clinical decision making with the most accurate diagnosis. However, the possible solutions for improving physicians’ calibration are challenging, since humans are not machines, and the learning process is much more difficult than using neural networks. Moreover, there are no universal “standard materials” that can be used in clinics, since there is no patient completely similar to another. Therefore, achieving a substantial improvement of diagnostic accuracy needs a multifaceted strategy, entailing recovered enthusiasm on traditional clinical skills teaching, systematic exploration of new educational approaches, a facilitating process for more effective teamwork and, finally, substantial focus of investments in basic science of clinical diagnosis.