Because I Said So
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.