WHY BIOCHEMISTRY IS NOT A LAUNDRY SERVICE: BUILDING MEANINGFUL CLINICAL INTERFACES ONE ANALYTE AT A TIME

Associate Professor Cherie Chiang
MBBS (Hons) FRACP FRCPA MAACB MD FFSc

A/Prof Chiang is a dual qualified endocrinologist and chemical pathologist. She is the Head of Chemical Pathology at Melbourne Health, the Head of Bone at Austin Health, Endocrine partner at ENETS Peter MacCallum Cancer Centre, and RACP Councillor. She chaired several AACB harmonisation working groups including endocrine dynamic testing

Abstract:

Biochemistry underpins modern clinical decision-making, yet it remains one of the least visible pathology disciplines. Unlike haematology and microbiology—where interpretive reporting, morphology review, organism identification, and direct clinician–laboratory dialogue are embedded into routine practice—biochemistry is frequently perceived as a high-throughput “laundry service,” delivering large volumes of numerical results with limited contextual interpretation. This perception persists despite biochemistry being the highest-volume pathology testing discipline in Australia and a cornerstone of diagnosis, monitoring, and risk stratification across virtually all areas of medicine.

The expanding availability of laboratory results through national digital health platforms, including patient access via My Health Record, has further amplified this challenge. Clinicians and patients increasingly encounter biochemical data outside established interpretive frameworks, often without sufficient understanding of analytical limitations, biological variability, pre-analytical influences, or clinical context. Consequently, biochemical results are commonly misconstrued as definitive answers rather than probabilistic data requiring expert interpretation.

Using illustrative clinical examples, this lecture argues that biochemistry is not a passive reporting service, but an inherently interpretive clinical discipline. Effective biochemical practice integrates physiology, pathophysiology, analytical science, and patient-specific context, one analyte at a time.