Second, one of your relatives has undergone a surgery to remove his gall bladder for some problem say for gallstones. The surgeon cut the gall bladder into three pieces and advised you to send the sample in to three different labs. Two labs reported the sample as inflammation of gall bladder or Cholecystitis and the other reported is as a cancer of gall bladder. Who is right? Perhaps all of them are right. Because the two, who received only inflammatory portion of the gall bladder reported these as inflammation. On the other hand who received the cancerous portion reported the sample as cancer. Then who is going to be blamed for this. None other than the surgeon. Because it is not appropriate to send surgically removed sample cutting into pieces. He should have adviced you to send the sample to a lab where he relies. The histopathology report is a black and white paper duly signed in by the pathologists. Moreover the sample, blocks and the slides are always available for second opinion, review inside or even outside Bangladesh. So it is not at all advocated to send the sample in different labs cutting into pieces. This will create confusion, involve extra expense and unnecessary harassment for the patient and relatives.

In ancient time, disease was diagnosed examining the patent's appearance, tongue, gait, pulse, colour of urine passed etc. But now a days due to advancement of medical science and technology, diagnosis of diseases have become mostly laboratory investigation oriented.

The presentations of disease are variable. Therefore reliable, accurate, timely given laboratory results are very important in the diagnosis and prognosis of the disease. Here comes the question of quality assurance with reliability, quality, dependable results and minimum errors in the laboratory results.

Medical errors can occur anywhere in health care system. Most importantly medical errors are one of the leading cause of sufferings of the ailing people which can even lead to some fatal condition. One recent report in USA stated that 44,000-98,000 people in USA die of medical errors more death than motor vehicle accidents, breast cancer or AIDS. But what about our country?

If we want to minimise errors in the laboratory results quality assurance is must. It includes activities both inside and outside the laboratory, good laboratory practice and proper management skill. It ensures giving right result at the right time, on the right specimen, from the right patient, with result interpretation based on correct reference data and at the right place.

In the present context of our country if we get an erroneous result what we usually do? We repeat the tests in many laboratories; the results are different at different labs; we as well as our physicians are confused. This leads increase of expense, extra botheration of running from lab to lab and which do not help the patients in terms of diagnosis and treatment at all. Then what is the remedy or answer if we get erroneous, doubtful, unreliable results? The answer is very simple. We must voice our concern and mobilise our efforts to establish a central reference laboratory and an institute of pathology. The concerned ministry should take immediate steps in implementing the project. The Society of pathologists and other laboratory professional organisation should come forward in this regard.

It may be mentioned that professionals of other disciplines have already established different institutes like kidney institute, mental health institute, cardiovascular institute, BIRDEM for diabetes and other endocrine diseases to further improved service, treatment, research in respective sub specialities. Some new institutes are in the process of establishment with the approval and financial assistance from the government. But there is no such institute or reference pathological laboratory has been established yet.

The proposed central reference laboratory will supervise and monitor the quality assurance of different tests done by different laboratories in the country. They will maintain an external quality control programme for all laboratories and give instructions to improve or modify procedures who lacks quality results. They will also provide guidelines for internal quality control, laboratory safety procedures, formulate one safe laboratory manual, proper waste disposal system and supervise it time to time.

The proposed Institute of Pathology will run different post graduate courses in different branches of pathology, conduct professional efficiency exam for specialists working in different branches of pathology and conduct research work. The authority of the central laboratory will monitor the activities of different labs all over Bangladesh, visit annually all the labs and verify the infrastructure, employment pattern, equipment and other facilities to run a proper lab. They will be empowered to cancel the labs which are not up to the mark. They will also sit and discuss with the society of pathologists about a fixed rate for different tests and ensure that this is followed strictly.

By establishing the institute of pathology and central reference laboratory, patients will get reliable and dependable result. This will reduce the medical expense, unnecessary harassment for erroneous results. Everyone of us should work together to fulfil this objective for the better healthcare delivery system in the field of pathology in Bangladesh.

The writer is the Head of the Department of Pathology of Ibrahim Medical College Hospital, Dhaka.