Towards Independent Practice
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.