While rounding with a medical team this past year, an intern presented a patient with diarrhea, severe dehydration, and renal failure. Several specimens had been sent to the laboratory for evaluation the previous evening. When the attending asked whether the house officer had examined the urine for casts or the stool smear for fecal leukocytes, the reply was, "Are you kidding?", implying that this action was not considered. This situation is not unique; my recent experience as a chief resident has indicated that undertaking a laboratory expedition is rarely considered. Although house officers have little free time, especially when they are on call, doing the little things that have an effect on patient care provides the physician opportunities for satisfaction, adventure, and education.

Hospitals have made taking care of patients much easier for resident physicians. Technicians work in clinical laboratories at all hours of the night, allowing the physician to spend more time contemplating the patient's illness and course of treatment. However, although responsibilities to patients often prevent the resident from spinning down urine samples or staining sputum samples, it is precisely these simple procedures that provide insight into the patient's illness. The 24-hour laboratory has allowed housestaff to become less aggressive at narrowing down a differential diagnosis early, even when the results will affect their immediate decisions. Most internists would agree that much of the satisfaction in caring for patients comes from trying to put together the pieces of complicated cases and establishing cause and effect. Therefore, personal inspection of critical test findings may not only result in more precise early treatment plans but, just as important, provide intellectual satisfaction for the house officer working through the case.

Interpretations of radiographic and pathologic test results are an essential part of patient management decisions, yet housestaff frequently learn of these results by simply reading the reports on the computer. Radiographic and pathologic test results should ideally be reviewed with the housestaff team to generate a picture of the patient and determine health care decisions. Pathologists and radiologists clearly have more expertise with interpretation and are necessary members of our hospital team. However, it is critical that their interpretation consider input from the patient's primary providers. If housestaff assume this role, it follows that they must be somewhat skilled at interpreting the information in most of the tests that are ordered. Teaching these skills should begin early in an internship because new housestaff have different levels of familiarity with laboratory techniques. Such an undertaking requires interdisciplinary efforts and easy access to patient specimens and required materials. Furthermore, teaching interns how to interpret test results early in the internship satisfies quality control issues.

Encouraging young physicians to examine specimens and diagnostic test results may consume valuable time; however, simple, important tests that narrow diagnostic considerations early in patient care are certainly cost-effective, particularly for acutely ill patients. Attention to these details in the total care of patients also makes our experience more rewarding. We must continue to educate housestaff in how to critically examine diagnostic specimens and test results. With this training, they will treat patients more efficiently and enhance their own diagnostic skills.