What Do Doctors Want from the Laboratory?
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
when I make this bold assertion, I receive one of four reactions:
blank stare. What are you talking about?
am a tech, not a doctor. That suggests discomfort, lack of preparation or lack
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.
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
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
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
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.