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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Towards Independent Practice

Published August 3, 2013 9:31 PM by Glen McDaniel

Over the years, I have served on many hospital committees including the Pharmacy, Nutrition and Therapeutics (PNT) Committee. This committee is usually chaired by a physician and has tremendous input from an infectious disease (ID) specialist, microbiologist, pharmacist and registered dietitian.

The laboratory has always acted as an ancillary department; providing information, but creating little if any policy. I worked with organizations in recent years in which almost the entire formulary was driven by pharmacy. Sure, physicians had input, but the protocol relating to choices of medication, storage and security of medication in the facility have been set up by pharmacy.

Georgia, like several other states, has had a problem with abuse of narcotics, including the acquisition of drugs through the use of forged prescriptions. It was the state Board of Pharmacy that spearheaded a move to make the prescription process more secure.  They drove legislation requiring among other measures that prescriptions for all Schedule II narcotics have to be written on the state board of pharmacy approved paper.

Pharmacists announced they reserved the right to reject any prescriptions not meeting those guidelines- or that were otherwise suspicious in nature.

Can you imagine the laboratory taking such a bold move by developing protocol and dictating standards for physicians to follow; albeit to protect patient safety?

Thinking about this difference in perception of- and expectation from- pharmacy and MLS led me to read again the ASCLS statement on the independent practice of medical laboratory professionals.

It reads, in part:

"It is the position of the American Society for Clinical laboratory Science (ASCLS) that clinical laboratory
testing is the  defined practice of qualified medical laboratory professionals and encompass the design, performance, evaluation, reporting, interpreting and clinical correlation of clinical laboratory
testing, and the management of all aspects of these services."

It goes to say that medical lab professionals have the requisite knowledge and skill to perform, correlate, interpret laboratory tests and (with appropriate graduate degrees) direct clinical laboratories.

Functions are firmly grounded in applicable state law and  CLIA regulations, according to the document.

Independent practice does not preclude collaboration with others on the health care team. But the profession does have a unique body of knowledge and scope of practice. "Artificial and arbitrary barriers to (independent) practice should not be erected," states the position paper.

Maybe it's time for us as a profession to test those largely unchallenged barriers.


That is the basis of the lack of recognition of our profession. we simply are too shy and reticent. We don't volunteer for projects. we don't speak up.

I work for  a large HMO. We have medical offices and hospitals in California and over the country. I went to a medical office to sub for a lab scientist who was on vacation. Every person I met in the office welcome me and knew who I was.

doctors and nurses asked when I was going to lunch so they would handle their patient load and testing accordingly. Nurses asked my advice on point of care testing. Physicians asked me about tests for certain disease conditions.  One pediatrician admitted to me she had never understood the difference  between all the hepatitis panels available until I explained it to her.

I had never had that sort of recognition and inclusiveness in my career. The CLS I subbed for must have done a great job of establishing her niche on the team in that office. But that was the most exciting few weeks for me. I am on speed dial to cover for her whenever she is out.

We need to do more of that sort of collaboration.

Mervin Taylor, CLS ll August 25, 2013 2:54 PM
San Francisco CA

I have worked in the Bahamas, in the UK and in Jamaica and it seems like sometimes we lab techs outside America have it better than in the States. The doctor is always king but we tend to develop a relationship of respect and mutual admiration. My colleagues in the States all seem to lack this relationship.

I have worked with many doctors who discuss cases with me. They tell me what they are looking for. They let me know when my test/results prove or disprove their theories and help their diagnosis. It is more of a team and I love it. I am retired now but I miss that.

For some it took a while for them to warm up to me. But once they saw I was just as concerned as they were about the patients and I was knowledgeable in my profession they seem to respect me more.

I think it helps to develop a relationship with the doctor and they will respect you and treat you like a colleague. Just my thoughts.

Erica Smith August 5, 2013 5:01 PM

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