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Press Start: Lead an Empowered Life as a Clinical Laboratorian

What Do Doctors Want from the Laboratory?

Published August 17, 2014 3:05 PM by Glen McDaniel

As anyone reads my writing knows I am a huge proponent of a more independent practice model for Medical Laboratory Scientists (and MLTs to a degree). A component of that model would be closer interaction with physicians and a willingness and ability to consult with physicians offering advice and information on medical laboratory testing.

Often when I make this bold assertion, I receive one of four reactions:

  • A blank stare. What are you talking about?

  • I am a tech, not a doctor. That suggests discomfort, lack of preparation or lack of knowledge

  • He/she is the one who went to medical school. This might be an unwillingness to use valuable time “teaching” professionals who should already have that knowledge. There might also be a willingness to give up information freely to someone who would then use it without giving credit.

  • They don’t need our help. This last one may be a combination of  the above or simply incredulity that doctors would “stoop” to asking for help in any way

Coincidentally, 2 studies crossed my desk in the past couple of weeks; both vindicating my long-held viewpoint and in fact giving in objective terms when and how doctors would need help from the laboratory.


The first study was more of a survey conducted by the CDC’s Clinical Laboratory Integration into Healthcare Collaborative (CLIHC).  The survey evolved from several focus groups conducted by CLIHC and sent to over 30,000 primary care practitioners (PCPs). They had a 5.6 percent response rate, that is 1,768 PCPs responded (Journal of American Board of Family Medicine 2014; 27:268-74).

Of the findings, 2 struck me pretty significantly.  Even though PCPs see a large number of healthy patients including younger people and well adults, they reported ordering laboratory tests in 31 percent of their patients. Further, they had difficulty ordering tests and interpreting results in 15% and 8.3 percent of patients respectively. Those percentages might seem small, but the authors of the study point out that there are more than 300 million PCP visits in the US annually. That’s a lot of patients potentially having the incorrect test ordered or results misinterpreted.


To further place this in context,John Hickner, MD, lead author of the study who is professor and head of clinical family medicine at University of Chicago Medical School, said in Quality Improvement terms (e.g. LEAN) even a 1% error is unacceptable, yet this study shows a total error of over 20 percent. “This is a big problem,” Dr Hickner says.


Another huge area of concern for doctors is the cost of tests. They receive pressure from hospital administrators and patients to contain cost, but they have no idea how much different tests cost.


So how do physicians typically cope with knowledge gaps in these areas? They use e-references, refer patients to specialists (you handle this!) or use curbside consults (John what do you think of this patient's results?) Specifically asked about consulting the laboratory they said that lab consults would be very valuable and would be welcome. However they do not do it because it is not offered. Despite the perceived lack of that option, an optimistic and persistent 6 percent of doctors do still try to consult the lab, however.


I would welcome feedback about your opinions on these findings and I will continue discussing the findings of this important study. I will also describe the second (totally separate) study I mentioned in my introduction.  Some questions to ponder: specifically why do physicians think lab consults are not available? Do those intrepid souls who seek out the lab find the lab helpful? Do they ever change their mind after speaking to a laboratorian?


We’ll discuss those and other questions in my next two blogs.


I have family members who work in the laboratory and they have been very helpful to me in terms of offering suggestions and education. I notice it is very difficult to get anyone in the lab to commit if you ask a question.

They ask me more questions about who I am and why I want to know. Them they transfer me or say someone will call me back.

I am a resource for nurses so I help with workload, educate and track down information for staff nurses to help them do a better job. I find other ancillary departments very willing to help and answer questions.

I am glad I happened on this article. It explains a lot, it is also interesting. I am not a physician, but I too have experienced the hesitancy from the lab, and I would welcome more help from the lab.

Janice McGovern, RN, Resource Nurse August 26, 2014 11:22 AM
Baltimore MD

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