Laboratory medicine in central and eastern Europe: Can we catch up?

Laboratory medicine, as defined by the IFCC and FESCC, is the application of chemical, molecular and cellular concepts and techniques to the understanding and evaluation of human health and disease. At the core of the discipline is the provision of results of measurements and observations relevant to the cause of disease, the maintenance of health and the conversion of these data into specific and general patient- and disease- related information at the laboratory-clinician interface. The discipline is committed to deepening the understanding of health and disease through fundamental and applied research. Furthermore, there are increasing health care expectations and consequently increasing demands of health care resources. Because of the increasing health costs, governments of many European countries have cut health care expenditure, often by decreasing the funding of acute care facilities, closing hospitals, outsourcing services or privatizing health care. Medical laboratories, highly dependent on rapidly changing, expensive and sophisticate technologies, have especially been affected by these policies. Several trends in medical laboratories are developing simultaneously: ? Centralization of diagnostic medical laboratories, rationalization of services, increased emphasis on cost-benefit analysis and cost-effective total patient care, linked to improving outcomes. ? Development of highly specialized laboratories at the interface with research. ? Implementation of point of care technology. ? Development of molecular biology procedures improving diagnosis of infections and inherited diseases. ? Computerization and telecommunication, which facilitates fast communication between laboratory and clinicians. ? Automation and robotics are changing the face of classic laboratories. ? A general trend towards accreditation or certification of laboratories in order to increase and recognize quality and excellence, including consultation services, pre -and post-analytical procedures. Medical laboratory specialists, whether of medical or non-medical training background, are responsible for comprehensive laboratory services including production of analytical results, consultation with clinicians, management, quality assurance, and computer technology. When possible, they conduct research and training in laboratory medicine. There are considerable differences among countries - in particular between highly developed countries of the European Union and countries of Central/Eastern Europe - in social, economical and health system developments, which affect the practice of medicine. The ultimate goal of laboratory specialists in the Central/Eastern European countries is to catch up with all these processes and also to reduce the gap between east and west in this respect. However, sufficient governmental financial resources are lacking as well. Thus, national laboratory societies bear a higher than ever responsibility in working out and implementing successful strategies, convincing public opinion, political opinion-leaders and the media about the importance of laboratory medicine, a discipline inevitable for successful predictive, preventive and clinical curative medicine.