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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Labs Have a Role in Fighting Diagnostic Error

Published November 14, 2015 10:58 AM by Glen McDaniel

In 1999  the Institute of Medicine (IOM) published that seminal report, To Err is Human: Building a Safer Health System.


We can all recite the much-quoted statistics that medical errors result in between 44,000 and 98,000 deaths in this country each and every year. The report rated medical errors as the 8th leading cause of death.

 

It is a reasonable expectation that this stark reality, together with the adoption of best practices, and the advancement of medical technology would have improved that situation quite a bit in the ensuing years. But has it?

 

I just finished reading James Lieber’s  book, Killer Care:How Medical error Became America’s Third Largest Cause of Death.  His book paints a grim picture, as he summarizes studies and research over the years. He often refers to the cost of medical errors by using terms like potentially compensable events (PCE), adverse events and performing human factor analysis after an error. He also gives his prescription for tackling this huge problem.

 

An often overlooked cause of medical error is misdiagnosis.Because  the laboratory produces the majority of objective information used in medical decision making, the lab obviously plays  a pivotal role in diagnosis. In fact a  recent report from IOM estimates that misdiagnosis contributes significantly to at least 10 percent of patient deaths. 

 

Medical laboratorians working with other healthcare professionals  like physicians, nurses and pharmacists- as a team- could reduce this number. More than that, they have  a responsibility to decrease misdiagnoses and medical-error deaths.

 

AACC president David Koch, PhD supports this idea and points out that laboratory medicine professionals have a wealth of knowledge, a unique body of knowledge, that if properly tapped would go a long way towards better patient care. “If involved in day-to-day consulting (laboratorians) can provide vital insight to find better, faster and more precise answers to challenging health care problems” Koch states.

 

What has your organization, or you personally, done to contribute MLS  knowledge to improving the efficiency and accuracy of diagnoses? Do you ever intervene or go beyond the “well, he/she is the doctor” hands-off approach? I would love to hear from you.

3 comments

Great blog. I think it's interesting you end by saying, "he or she is the doctor." I think you are alluding to the fact that many times we as healthcare professionals do not question the doctor. We presume the doctor always know best.

As a nurse and a Med Tech, I have a dual broad view.  Especially in my current role as a nurse, I know we have to remind the doctor of many things. We notice the subtle changes in the patient. We know when a treatment is not working. A good doctor knows to depend on the nurse and not arrogantly say, I am the doctor.

I have the upper hand because I also use my laboratory knowledge when making decisions. Lab techs are more critical in their thinking than nurses. I will also gently make suggestions about different tests and what they mean. Which are useful and which are almost useless or wont change that much over time.

I make sure specimens we send are collected properly, not hemolyzed, and are adequately labeled.  My colleagues are surprised but happy when I explain the ins and outs of the laboratory. They might know what sometimes, but not why.

We really are a team and patients get the best care when we are all allowed to fulfill our role. Yes he/she might be the doctor. But that's exactly it, they are the doctor who knows "doctor stuff." They do not know nurse stuff or lab stuff. So they need nurses and med techs for better patient care.

Maryann Taylor, RN, MT(ASCP) November 14, 2015 2:43 PM
Annapolis MD

This is a worry for me that in America biomedical scientists do not get the respect they deserve. I worked in my country of Nigeria and also in New York. I get more respect here in Lagos. I was losing my skills in New York because we had so much work and had to work so fast. We made sure to avoid errors but it was more like we had to produce like  a factory. Here I see patients and I see doctors. They will ask my opinion and they tell me when my input help them to treat a patient. We might not be as advance as the USA in some ways but we use our skills and knowledge more. I can still do a manual test because I keep fresh on the theory. I will go the extra mile and say hey doc I saw this or that and he will say thanks and order it so the result can go into the patient record. So many times we in the lab find something the doctor was not even looking for. That make us more confident because we know we help in better and faster diagnosis. Thank you.

Olufemi T , Lab - Biomedical Scientist, Hospital November 14, 2015 12:14 PM
Lagos IT

CMS and the all payers are moving towards outcomes based medicine. We will be reimbursed more for better outcomes. Just as significantly we will be penalized for "less good" outcomes.

It just makes sense we use all the tools in our arsenal to help the patient quicker, make them well, get them out of the hospital faster and use less resource.

I certainly call on my laboratory scientists and I give them credit when consulting with clinicians. But we as pathologists could do a better job and be more effective if we drove laboratory consultations, not just for us, but by pulling in the entire laboratory team with their vast knowledge.

Dr. Ann Koch November 14, 2015 11:27 AM
Los Angeles CA

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