Last week, I encountered a situation that made me pause and reflect on how laboratory availability directly impacts patient care—and not in a good way.
I was covering for a colleague at one of our larger metro hospitals when I saw a patient with recurrent abdominal abscesses (pus in the abdomen) associated with sigmoid diverticulitis- an inflammation of the large intestine.
The patient had been admitted to the hospital three times in six months and received multiple rounds of antibiotics, but it keeps recurring.
All the cultures had been negative (ie no organisms are seen), this can be due to prior antibiotic use or the organisms causing the infection is one of those that are impossible toculture .
This seemed like the perfect scenario for metagenomic next-generation sequencing (mNGS)
mNGS is a fantastic tool that can identify virtually any microorganism in a sample by sequencing all DNA or RNA present.
So I requested the test, excited about possibly finding answers for my patient.
Then came the response:
"Sorry Dr. Agbaosi, your test cannot be done now because it is Friday evening. The earliest it can be done is Monday morning next week."
When Labs Close, Diagnosis Waits
The issue wasn't with the hospital itself but with the laboratory that performs the testing.
Despite being a critical diagnostic tool, mNGS testing was only available Monday through Friday, mornings only.
This creates a troubling scenario:
A patient needing a diagnostic tool has to wait simply because their medical need didn't align with a laboratory's business hours.
Infection doesn't clock out at 5 PM on Friday and return Monday morning!
For my patient, this translates into:
→ Extra days in the hospital
→ Continuing broad-spectrum antibiotics without knowing the specific target
→ Added healthcare costs
Is Competition The Solution?
As my mentor wisely pointed out in our discussion (detailed in an earlier article here), only competition will force change for the better.
I feel this situation perfectly illustrates that principle.
When laboratories operate as the sole provider of specialized tests, they have little incentive to expand their hours or improve accessibility.
It's like having only one coffee shop in town, they can set whatever hours they want because where else would you go?
We need more laboratories to step up and offer mNGS advanced diagnostic services.
With multiple labs competing:
📌 Hours of availability would likely expand
📌 Response times could improve
📌 Costs will most likely decrease
➡️ Patient care would ultimately benefit
Metagenomic sequencing isn't just another test—it's a game-changer especially for difficult cases.
When traditional methods fail to identify a pathogen, mNGS can provide crucial answers that guide targeted treatment.
For my patient with recurring infections despite multiple antibiotic courses, having this diagnostic information could mean the difference between continued suffering and targeted healing.
The technology itself is remarkable!
It's the delivery system that needs work.
Think about it this way - A powerful fire truck that only operates during business hours!
I believe that through ADVOCATING for change and highlighting the REAL IMPACT on patient care, we can create healthcare systems that truly serve patients, regardless of when they happen to get sick.