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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Because I Said So

Published June 20, 2009 3:55 PM by Glen McDaniel
Remember as kids, how your parents would explain a directive with a terse "Because I said so." Or simply "Because!." That response demonstrated a significant imbalance of power between the parent and child.

Healthcare providers are familiar with superiors or physicians sometimes demanding that providers act in a manner against the provider's better judgment, scope of practice or established policy and procedure "because!"

Recently, I  was privy to 3 separate instances in which laboratorians were "ordered" to act simply for the convenience of someone in authority. An ED physician insisted that electrolytes be performed on an EDTA specimen because the nurse lost venous access to a hard to stick patient and after several attempts they could collect only a CBC specimen. All entreaties and explanations from the technologist and laboratory supervisor- that the anticoagulant contained significant amounts of potassium -went unheeded. The physician essentially said "I am the physician, do as I order and I will evaluate the results as I see fit."

The second instance involved a nephrologist insisting that "all creatinine clearances from your lab are useless" because his manual calculation differed from the one on the laboratory report. It's true the lab did not correct for the patient's body surface area, but the explanation of typically reporting clearances based on a "normal" BSA just drew more ridicule and expletives from the doctor.

The last instance was of a director who had acquiesced to a cardiologist's demand to adopt reference intervals and diagnostic cut points from another local hospital lab that the cardiologist admired. The director pressured the lab, despite ethical, regulatory and scientific concerns. One wonders why a physician would want to substitute a laboratory interpretive report (based on faulty science) for clinical judgment. And why would that dangerous precedent not be evident to the director?

Our reputation, value and perception -as true educated professionals with critical thinking skills and independent judgment -are compromised every time a laboratorian acquiesces to an order "just because."

I would love to hear from readers about examples of similar demands, your response and your view on this entire matter.

2 comments

I have a Tennessee license and have worked in several labs for over 15 years. I am good at what I do and keep up to date on the latest technology and knowledge in the field. Yet I am treated like a moron sometimes by doctors and even nurses (of which I am most times more educated). Hellooo!%0d%0a%0d%0aWhen they insist we do something stupid such as test an inappropriate specimen or set up a urine setting at room tempearture for 10 hours, after we have dipped into it to do urinalysis, we dont feel like we can say no. Or if we say no, we will be overruled.%0d%0a%0d%0aOur supervisors wimp out and dont support us. We refer doctors to a pathologist who then side with the doctor 100% even though the pathologist knows darn well we the technologist are right. They would rather support their fellow doctor than make sure the results are right.%0d%0a%0d%0aMost of the "bad results" that leave labs are because others order us to do what we know is wrong. How can we stop this madness??

Jonas. MT (ASCP) , Medical Technologist June 26, 2009 6:10 PM
Chattanooga TN

Sorry doc..  I am not putting my license at risk to merely produce numbers to appease your demands.

I also vehemently refuse when a nurse demands when we do so.  Whether it be a short blue top, a purple poured into a gold top or a clotted CBC..    

Yeah right..  Redraw it properly and I will give you accurate results, not just numbers on a chart so you can go home.

Ryan June 21, 2009 9:29 PM
NY

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