Step Up to the Challenge of Schooling Pathologists
I recall a conversation I had with a pathologist not so long ago. She indicated that after a medical staff meeting she was asked by an internist if we offered" that new test that is replacing the PTT." I immediately suspected the physician was referring to the anti Xa assay used to monitor heparin therapy.
She said, "He did mention heparin therapy." So I went on to explain the aPTT did not always accurately measure the anticoagulant effect of heparin due to antagonists, heparin resistance and several preanalytical factors. When she stared at me blankly, I told her the theory of both tests and reminded her that the therapeutic range for aPTT is derived from anti Xa measurement of plasma from heparinized patients.
When her eyes glazed over completely, I summarized "In other words, you can more directly correlate anti Xa activity to a certain dose of heparin. So physicians, pharmacists and nurses will be glad to know fewer lab draws will be needed, results will be less erratic and the patient will reach the desired heparin therapeutic range faster." As she walked away, I offered to print out some information on anti Xa for her leisurely reading
My initial reaction to her response was a mix of annoyance and smugness. She was supposed to know this stuff; after all as the medical director she signs off on procedures, her name is on the laboratory license, and she consults with clinicians about using and interpreting laboratory tests.
Then I thought: as a professional clinical laboratorian, I had a legitimate role in the process. Explaining technical procedures, keeping abreast of developments in the field, consulting on the judicious use of clinical lab tests are all within my purview. It is an open secret that many pathologists concentrate so much on anatomical pathology (tissues, cytology, biopsies and the like) that they do not have the time to be experts on medical laboratory tests and the daily practice of MLS or the nuances of quality assurance.
As experts in our field we have an opportunity and obligation to offer current, credible information to pathologists and clinicians as needed. If we do not step up to the plate, others will fill the void-often with inaccurate and outdated information. So we ought to not just gladly accept questions, but we need to proactively provide information in a casual, matter of fact authoritative way, until the practice becomes acceptable and expected. "Schooling" others, even pathologists, is really an opportunity to shine-and benefit the patient.