Explaining lab results to clients within your scope of practice

Educating means telling a client what a result is, where it sits against a named range, and what that range means in general. Diagnosing means deciding what the result means for this person: naming a condition, or deciding on treatment. In most non-medical roles you can do the first and refer for the second. Where exactly the line falls depends on your profession, your credential and where you practice, so check it with the body that governs your work.

I build Sera, a lab-review workspace for practitioners, and I'm not a lawyer. Nothing here is legal advice. It's a way of wording things that stays on the descriptive side, and a habit of writing down what you said.

Who decides your scope

There isn't one rule. Scope is set by some mix of:

• your profession and credential (health coach, nutritionist, registered dietitian, naturopath, nurse practitioner)
• the licensing law in your state, province or country, if your profession is licensed there
• your professional body's code of practice
• your employer, your insurer, or a supervising clinician

An NP may be able to order, interpret and act on the same panel that a health coach can only discuss in general terms. A dietitian's scope in one state can differ from the same credential next door. And moving to telehealth doesn't change the rules: it can mean the rules of the client's location apply too.

So before you build your wording, find your own answer in writing: from your licensing board, your professional association or your insurer. If the answer is unclear, ask them directly and keep the reply.

Educating and diagnosing, side by side

The same result can be described or diagnosed. The difference is mostly in the verbs.

A few habits keep you on the left side:

• Name the range and where it comes from. "Inside the lab's range" and "inside a target I use" are different statements. Say which one you mean.
• Talk about the marker, not the person's body. "Ferritin reflects iron stores" is education. "Your iron stores are low" is close to a conclusion.
• Leave the "why" open. A single result rarely has one cause, and naming the cause is usually the diagnostic step.

Example wording for a high, a low and a borderline result

These examples use real thresholds with sources, so you can see how naming the range does most of the work. Adapt the wording to what your own scope allows.

A high result: hsCRP of 4.1 mg/L.

"Your hsCRP was 4.1 mg/L. hsCRP is a marker of inflammation. The American Heart Association and CDC group results above 3 as higher cardiovascular risk. One raised result can come from a recent infection or injury, so it's normally measured again when you're well. I'd like you to share this with your doctor, who can look at it alongside the rest of your health."

The categories and the advice to repeat it when well are on the hsCRP range page.

A low result: ferritin of 18 ng/mL.

"Your ferritin was 18 ng/mL. Ferritin reflects the body's iron stores. The American Society of Hematology uses 30 ng/mL as the point below which it diagnoses iron deficiency in adults. Deciding what this means for you, and whether anything needs doing, is your doctor's job, so please take this result to them."

The threshold is on the ferritin range page. Notice that the sentence names the threshold and who set it, then hands over the decision.

A borderline result: TSH of 4.3 mIU/L.

"Your TSH was 4.3 mIU/L. That's inside the 0.5 to 4.5 range the American Thyroid Association describes, close to the top. Labs print slightly different limits for their own test, and TSH runs higher in the early morning, so one result near the edge says less than a few results over time. It's worth repeating, and worth your doctor seeing if it stays there."

The range, the variation between labs and the daily rhythm are on the TSH range page.

If you use a narrower target. Many practitioners work with targets inside the lab's range. Say that it's a target and where it comes from, for example: "This is inside the lab's range, and below the target I work with. That target comes from..." Don't present a target as if it were the lab's normal range. The ranges library labels each band with its evidence grade, which is a useful check on how strong a target really is.

When to refer

Refer, or ask the client to contact the clinician who ordered the test, when:

• a result is outside the lab's reference range and nobody medical has seen it yet
• the lab has marked a result as critical or urgent
• the client describes new, worsening or worrying symptoms
• the next step would be a diagnosis, a new test you can't order, or a medication change
• the client takes medication whose dose depends on the result, such as thyroid medication
• you're not sure whether the question is inside your scope

The last one matters most. Uncertainty is a reason to refer, not a reason to guess.

How to refer

A referral that gets read is short and factual. Give the client something they can hand over, or write to their doctor with their consent:

• the marker, value, unit, date and lab
• what you noticed, in descriptive words ("above the lab's range", "lower than the last two results")
• what you're asking for: a review of the result, not a specific diagnosis or treatment
• your name, role and contact details

Keep the lab's original report attached. A doctor will want to see the number on the lab's own page, with the lab's own range next to it.

Writing down what you said

Notes protect your client and you. After any conversation about results, record:

• the date, and which results you discussed
• which range you compared each result with, and where that range comes from
• what you said, as close to your own words as you can
• what you said was outside your scope, and who you referred to
• the client's response, and whether they agreed to see their doctor
• when you'll follow up

If you later learn the client didn't see anyone, note that too, along with what you did next. Your professional body or insurer may have its own requirements for record keeping, so check those as well.

Written reports follow the same rules

A report you send home is read without you there to explain it. Keep it descriptive: the value, the range, the source of the range, and plain notes on what each marker measures. Leave out anything that reads as a conclusion about the client's health, and say in the report which results you've suggested they take to their doctor.

Where Sera fits

Sera's reports describe results. They show each value against a range whose sources and evidence grade are published, and they don't diagnose or recommend treatment, so the clinical judgment stays with you. Client reports carry your practice's logo and no mention of Sera.

It's free for three clients with no card. There's a 3-minute tour if you'd rather watch first.

Alina Radu is the founder of Sera and a software engineer. The idea started with her own Hashimoto's tests, scattered across years without the big picture.