Chinese medicine practitioners on the use of pathology

Yes, you may interpret pathology results where you have the appropriate applied knowledge and clinical competence to do so. The professional capabilities state that Chinese medicine practitioners can plan and perform efficient, effective, culturally responsive and patient-centered assessments. Planning assessments and analysing patient responses and information gathered can include drawing upon applied knowledge of pathology assessment, referral and outcomes.

Yes, however, prior to initiating any referral for pathology testing, you must ensure you have sufficient clinical and applied laboratory medicine knowledge to accurately interpret the results and formulate an appropriate management plan. It is a professional and ethical obligation to act within your scope of practice. If you are not adequately equipped to interpret the results of a requested test, you must not proceed with the referral. In such cases, you should advise the patient to consult their general practitioner (GP) or another appropriately registered health professional for further assessment and investigation.

Where a pathology referral is made by a non-medical practitioner, such as a Chinese medicine practitioner, the patient will be responsible for the full cost of the investigation, as the referral does not qualify for Medicare rebates. It is your responsibility as the referring practitioner to obtain informed financial consent prior to initiating the referral. The patient must be clearly advised, in advance, that they will be required to cover the full cost of the test, and that no Medicare subsidy applies in this context.

Where you initiate a referral for pathology or other investigations, it is your responsibility to ensure appropriate follow-up occurs. This includes arranging a follow-up appointment to review and discuss the results with the patient, formulating an appropriate management plan and documenting the discussion and actions taken. As the referring practitioner, you remain accountable for ensuring that the patient is made aware of the results and any necessary clinical implications arising from them.

Yes, you may interpret pathology results, provided you have the requisite knowledge, training and clinical competence to do so safely and effectively. Pathology is included as part of the accredited education and training for Chinese medicine practitioners. However, in accordance with the shared Code of conduct, practitioners must always recognise and work within the limits of their professional skills and competence. If interpretation of pathology results falls outside your scope or confidence, you must refer the patient to a suitably qualified health practitioner. You must only interpret pathology reports where you are confident that doing so poses no risk to patient safety and is in the patient’s best interests.

The treating practitioner retains an ongoing duty of care towards the patient, which includes the responsibility to ensure that all pathology results, particularly those that are abnormal or clinically significant, are reviewed and appropriately communicated to the patient in a timely manner. This obligation is especially critical in situations where results may indicate a need for urgent clinical intervention.

If you are not confident in your ability to interpret a pathology report, you must not initiate a referral for pathology testing. Instead, you should advise the patient to consult their GP or another suitably qualified registered health practitioner. Referring a patient for investigations without the requisite knowledge to interpret the results constitutes a breach of your duty of care. As a practitioner you must not assume or rely upon another health professional to take over responsibility for the interpretation and follow-up of pathology results without the informed consent and prior agreement of that professional.

If a patient presents with an existing pathology report that you do not feel competent to interpret, the patient must be referred to an appropriate health professional for further review and explanation. It is vital to remember that interpreting diagnostic investigations without adequate competence may pose significant risks to patient safety.

If you wish to improve your understanding and clinical use of pathology, you are encouraged to carry out further education through accredited training providers or professional associations.

If you are unsure about whether it is appropriate to refer a patient for pathology testing, you should carefully consider the following questions:

• Is there a clear and clinically appropriate reason for the pathology test?
• Are you confident in your ability to accurately interpret the results, communicate them in a timely manner and formulate a safe and appropriate management plan?
• Does the patient provide informed consent for the referral?
• Is the patient aware of and willing to accept any out-of-pocket costs, including the lack of Medicare rebate eligibility for tests referred by non-medical practitioners?
• Have you considered whether the test results may require timely or urgent medical follow-up that may be outside your professional scope of practice?
• Do you have clear documentation processes in place to record the rationale for the referral, informed consent and any follow-up arrangements?
• Is the referral free from potential risk to the patient, such as delaying necessary clinical care?
• Do you have a contingency communication plan in place for managing clinically significant or urgent results that may be received outside of normal consultation hours?

If the answer to any of the above questions is ’no’ or if you are uncertain, you should not proceed with the pathology referral. Instead, you should advise the patient to consult their GP or another appropriately qualified registered health professional.

If you are not able to refer a patient for a pathology test, you should explain your reasoning for seeking a referral to the patient and obtain informed consent to proceed. You should record in the patient’s health record whether the patient accepted or declined the referral. If they accept the referral, you should then provide a written referral letter that summarises your concerns, findings and any history relevant for seeking a pathology test.

You should then encourage the patient to take this letter to their GP or another appropriately qualified registered health professional, who will be able to refer them for pathology testing. The referral letter should be documented in the patient’s health record.

A patient is entitled to decline your suggestion for a pathology referral. If this happens, you must:

• respect the autonomy of the patient
• clearly explain the potential risks of declining the referral to the patient
• document the discussion and the patient’s decision in the patient’s health record.

These steps help protect the patient’s wellbeing and support you in meeting your professional and legal obligations.

In general, Chinese medicine practitioners are not authorised to independently conduct pathology testing or collect blood samples from patients. However, some Chinese medicine practitioners may also hold registration or qualifications in other regulated health professions that permit them to conduct such testing, provided it is within the scope of that profession and carried out in an appropriate clinical setting.

In Australia, only approved pathology practitioners or health professionals with a valid Certificate III in Pathology Collection (HLT37215) practicing in accredited pathology laboratories can provide pathology services. In order to be accredited, a pathology laboratory must meet specified quality standards, which are checked by the National Association of Testing Authorities (NATA).

Yes, with the patient’s informed consent, interprofessional communication is encouraged and supports integrated care. It is a principle of the shared Code of conduct that you should practise in partnership with patients and colleagues, using patient-centered approaches, and informed by the best available evidence to achieve the best possible patient outcomes. You must always maintain patient confidentiality.

Yes, a patient health record should be made in accordance with the Board’s Guidelines on patient health records. It is good record-keeping practice to retain a copy of pathology test reports discussed with the patient or used to inform your treatment plan as soon as they become available. As per the guidelines for patient health records, it is your responsibility to ensure they are securely stored and comply with the provisions of relevant state, territory and Australian laws relating to privacy and patient health records information.

Chinese medicine students cannot make referrals for pathology tests. However, as they will be in supervised practice, their supervisor can make referrals for pathology tests, provided they adhere to the guidance set out on this page.

When referring a patient for a pathology test, be sure to check that the service you are referring to is an accredited pathology laboratory. A searchable list of accredited pathology labs is available on the NATA website.

• Professional capabilities for Chinese medicine
• Shared Code of conduct webpage
• National Association of Testing Authorities
• Guidelines on patient health records