I work in a university affiliated cancer center lab, inside of the largest hospital in my area. Due to a weird contract signed many moons ago, we are very restricted in the lab tests we are allowed to run for the cancer center physicians (employed by the university). the dumbest example is this: the total/direct bilirubin ratio. Total bilirubin is one test that we run on almost every patient as part of the comprehensive metabolic panel. Direct bilirubin is less common, but we do run a fair few of them. The calculation for the ratio is simple division. But when the ratio is ordered as a standalone test, it must be sent to another lab in the hospital megacampus. But not the gigantic lab in the main building, the lab in the children's hospital. Nobody has a good explanation for why I must send this test off into the wild blue yonder instead of simply doing some arithmetic, and I'm beginning to doubt that there is one at all.