Welcome to Health Care POV | sign in | join
Press Start: Lead an Empowered Life as a Clinical Laboratorian

CAP Q-Probe Looks at Physician Satisfaction with the Laboratory
March 29, 2015 4:49 PM by Glen McDaniel

A recent College of American Pathologists (CAP) Q-Probe investigated the level of physician satisfaction with what the laboratory has to offer. I always find satisfaction surveys instructive and this one was no exception.


This Q-Probe is certainly not the first of its kind or scope, but is the latest. The study’s authors Shannon McCall, MD and Larry Massic, MD  had a sample size of 2425  physicians from 81 institutions and asked  16 laboratory-service related questions.


-The overall satisfaction was 4.2 on a scale of 1 to 5 (this compares to a 2007 study in which the score was 4.1)

-Physicians  were most satisfied with quality of results, test menu and staff courtesy. They were least satisfied with turnaround time (TAT) for STATS (inpatients and outpatients), and esoteric tests.

-Interestingly, in terms of what providers considered important to them, clinical report format scored fairly high as a service category

-Only 69  percent of respondents were satisfied with the ease of use of electronic order entry. This was a surprise; as ubiquitous as that function is these days.

-95 percent of physicians said they would recommend their laboratory to another physician.


What are some of the takeaways?

-Physicians are confused by the increasing amounts of data they must process and find it harder to extract what’s significant and actionable.

-Physicians in smaller hospitals tend to be more satisfied with laboratory service than those in larger settings. The study authors theorize that this difference might be due to closer, more frequent interaction between providers and the laboratory staff in smaller facilities

-Overall, despite some degree of frustration on both sides, physicians are basically satisfied with the lab, but would welcome greater interaction and “help” in several areas including selecting and interpreting lab results

-Turnaround time rates low on satisfaction because it rates so high on the “importance” scale. So whatever we can do to reduce TAT is welcome and is translated in a physician’s mind to “better  service.” We could also do a  better job of educating doctors as to what is included in getting a test from order entry to result. They do not necessarily understand all the steps involved, or the differences for different tests. Again, that is where communication comes in.


Dr. McCall gives the following advice, “Pay more attention to order selection and entry, as well as the method and frequency of communication of results in the post analytical phase. Then maybe we will see an improvement in physician satisfaction.”


This is just the latest in a growing number of studies where doctors say what they need from the lab. It is not coincidental that "help" and "communication" are repetitive themes. To me, this represents a real opportunity for laboratorians to expand their scope, boost satisfaction and contribute to enhanced patient care ; all at the same time.




Time for More Virtual Meetings Using AvailableTechnology
March 22, 2015 1:47 PM by Glen McDaniel
This is the time of year when the major medical laboratory organizations hold their national meetings. These gatherings are a great opportunity for laboratorians to get together with their professional colleagues from around the country and also to listen to major players in the profession and on the cutting edge of science.


 The advantages of national face to face meetings are undisputed: to learn new information, exchange information with each other, to network and to interact socially. Many meetings are held in interesting cities, so attendees also take advantage of what the host city has to offer; with many partying or getting much-needed rest and relaxation.  Some even take this opportunity to have a family vacation. Most meetings have a vendor exhibit or exposition (ranging from modest to gargantuan) of some sort associated with the meeting.  This offers a unique opportunity to talk to vendors, to see and touch advanced technology.


The thing is, it has become more and more difficult for the average bench MLS/MLT to attend national meetings. Most organizations do not offer financial sponsorship for meetings and, increasingly, laboratorians have to use their own money and often utilize vacation time or PTO. What’s a laboratorian to do?


While highly structured meetings are important for the reasons above, the reality is that organizations must offer alternatives for those laboratorians who cannot reasonably attend a meeting in person.  Communication technology has advanced to a great degree to offer several viable options.


-Webinars where an individual could pay to “attend” one or more presentations

-Live streaming of presentations and vendor exhibits

-Sale of CDs after the meeting

-Access to a password-protected website for audio and visual presentations

-Use of social media like Twitter and Facebook for some presentations where individuals can participate and ask questions in real time from wherever they are

-TED-like presentations of keynote addresses and high-interest topics

-Use of technology available on smart phones like the recently launched Meerkat application

-Offering CEUs as appropriate for participation through these virtual means



All of these options can be monetized ( I hate that term) of course. It is possible to charge so that laboratorians would pay a sort of “fee for service” cost. These charges would defray costs for the organization or, more likely, be a nice source of revenue for the presenting organizations.  Even if the cost was higher than the meeting registration fee, it would still be a cost savings because the individual would not have to pay for travel, meals away from home, hotel etc. and the other typical go-to-meeting expenses.


Not every organization has the wherewithal to offer all these services out of the gate, but it would be nice to see an incremental move in that direction.


 Vendors  have a vested interest to subsidize some of the cost, by the way.  Here is a likely scenario: Vendor A allows a virtual tour of their expo booth, ability to have a Q&A online and then allow the viewer to see one presentation for free (could be a big keynote or a scientific session).  The vendor bears all the cost. I can even see a situation where the exhibits are less gigantic, with some of the savings being used to facilitate virtual attendance and participation.


Face to face meetings are hard to beat and will not go away any time soon. However, the reality is that they are inconvenient and expensive to attend. Luckily technology offers many convenient, affordable alternatives. It is time to take advantage of this technology.  I know many meetings sell CDs, I know some offer some CEUs after the fact, but I am suggesting something much more comprehensive, bold and overarching. .


The technology is there and the laboratorians are there. It’s time to bring them together.

The Laboratory’s Expanded Role in Managing Kidney Disease
February 22, 2015 4:30 PM by Glen McDaniel

Kidney disease is one of the most significant chronic ailments affecting Americans. Renal disease is often a sequela of one of several maladies that plague Americans: diabetes, hypertension, glomerulonephritis, autoimmune disease, polycystic kidney disease and others.


An estimated 20 million Americans have chronic kidney disease (CKD) some managed by diet, exercise and medication alone, while others need regular dialysis.


Quality of life can be adversely affected and impacted by kidney disease.


The laboratory plays a crucial role in the diagnosis and treatment of renal disease. One of the ongoing challenges for providers is the variation in tests performed by different laboratories on different platforms using different reagents.  There have been several attempts to create harmonization to standardize results and make it easier to interpret results from various labs and even from visit to visit.


In late 2012 some guidelines called the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for the Evaluation and Management of CKD were introduced.


These guidelines were developed  through the collaboration of many international experts and build significantly on lessons learned from previous guidelines. One very important aspect of this guideline is that it contains strong recommendations for laboratory input and involvement in the process of care. It only makes sense that the experts who provide the information used in decision making should understand the recommended best practices and the rationale for such practices.


Not surprisingly, laboratory involvement will require a more active participation, rather than the typical passive behind the scenes “just do what the doctor orders” traditional approach.


Among the “Key Factors for Laboratorians” required by the 2012 KDIGO Guideline are the following


-Ensure good communication between laboratory professionals and relevant clinicians, such as nephrologists and primary care doctors.

-Aim for common laboratory practices in a region so patients receive the same care with comparable results from visit to visit, regardless of location where the testing is performed.

-Ensure creatinine results are aligned to an isotope dilution mass spectrometry standard (IDMS)

-Select an appropriate glomerular filtration Rate (GFR) formula for your population.

-Laboratories should use the same units, number of significant figures and clinical decision points for both serum creatinine and eGFR reporting.

-Laboratories should understand, and provide information on, their creatinine method, including any limitations and interpretation

-Laboratories should provide measurements of urine albumin and urine creatinine using traceable assays. These tests might be part of a periodic monitoring protocol in a high-risk population such as  known diabetics.

-Laboratories should provide Albumin/Creatinine ratio (ACR) and do so in a clear, consistent manner to help clinicians make correct decisions regarding declining renal function in any one patient from site to site and visit to visit.


All of these recommendations make good sense and offer yet another chance for the laboratory to be an active participant in patient care. This involvement should provide job enrichment as the laboratorian assumes a greater proactive and professional role. However, these are recommendations, not mandates.


 If laboratorians are hesitant and acquiescent then another player will step forward. Then once again, someone outside the laboratory, perhaps with limited knowledge of MLS, will direct “the lab” on what to do. It’s our choice, really.

Laboratory Inspectors: Using Peers Versus Employees of the Agency
February 15, 2015 3:39 PM by Glen McDaniel

I  was speaking to a group of laboratorians including a pathologist, and the conversation turned to laboratory inspections. At first everyone was on the same page: inspections are a necessary evil in the sense that it is important to have some neutral measure of quality, but the inspections could be very stressful.


Each person recounted horror stories of overly-picky inspectors or citations that were just arbitrary or inexplicable as far as they were concerned. The pathologist was very adamant that medical directors should be exempt from such scrutiny. One older scientist told the group stories of lowered practice or low-quality practices being adopted at the urging of medical directors who in fact had the real power in the lab. The pathologist insisted, quite rightly, that such occurrences were probably few and far between.


I then asked the group should inspectors be practicing peers drawn from sister- laboratories or should they be professional inspectors employed by the agency or the state.  I have witnessed both practices-Joint Commission , State, CLIA and COLA professional inspectors  on the one hand, and CAP peer-inspectors on the other.


The group was about evenly split. The pathologist liked the idea of peer pathologists (doctor to doctor). A couple of scientists insisted it takes someone in current practice to be  knowledgeable and realistic enough to “judge” their colleagues. They suggested professional inspectors were often retired individuals “ who had not seen the inside of a real lab in years- except during inspections” They might not understand current medical laboratory practice and their expectations were often unrealistic, for example.


Interestingly, the younger members of the group unanimously thought it would be better to have only professional inspectors instead of peers who only volunteered from time to time. Why? They thought professional inspectors  would be better trained, more current on the standards and would adhere to interpretation of standards in a more objective way. Peer-scientists tend to be more subjective and tend to “judge” laboratories more in comparison to their own experiences. In short, they were more rigid and there was more variation among visits and among inspectors, they thought. Interesting.


I guess there are advantages to both models. But since most laboratories are CAP-accredited, using volunteer peer-laboratorians it seems, the issue is of more than academic interest. Do you prefer being inspected by a team of practicing scientists who are just taking time off from their own labs, or would you prefer a team of professional full-time inspectors, who do nothing but laboratory inspections?


I would be interested in hearing your opinions.

The Laboratory: Operating Behind the Scenes
January 31, 2015 1:01 PM by Glen McDaniel

The mantra of most laboratorians is, “We get no respect.” The wrenching truth about that is that it is a self-fulfilling prophesy. We provide the majority of empirical data used to make clinical decisions, we are among the most educated of healthcare professionals. Yet the truth is we are under-recognized and often underpaid, as compared to our healthcare colleagues.


I am not sure what medical laboratory education is like these days, but when I was in school, our studies were heavily scientific. We studied the biochemistry of human functions, the anatomy of the body and a good deal of time was spent “diagnosing” based on laboratory data.


Then we graduated, interned in an actual  medical lab and found that our knowledge and critical thinking skills were grossly underutilized. To make it worse, burnt-out laboratorians slapped us down (figuratively) whenever we dared to be audacious enough to think we could offer an opinion.


I have written several blogs discussing research that indicates that what physicians want from the lab is accurate, timely results. In fact, they are lost without that. That’s a given. But they also want consultation. They want help selecting and interpreting tests. When they call they want to speak to a professional laboratorian to have their questions answered, someone who will help them solve their dilemma. Plus they want to do this without too much trouble. In one CDC surveydoctors said they often just hung up as they were transferred from person to person when all they wanted was something as simple as what swab to use and why one specimen was acceptable and another not. They wanted “why” not some snide comment  like “that’s just what we use” or to be told “ask the pathologist” for just about every technical or clinical query.


I call the “no respect” prediction self-fulfilling  because as we get disillusioned and shut down or don’t bother to keep up with clinical and technological advances, physicians and nurses trust us less and assume they know more than we do. Even about OUR body of knowledge and our scope of practice.


Articles written about the lab often reflect the same dumbed down narrative of who we are and what we do. A few days ago, I was very heartened to read an article in US News and World report that talks about the value of the laboratory and the fact that, despite our pivotal role, we still operate largely behind the scenes.


The article accurately describes the roles of laboratorians, even using the correct title of medical laboratory scientist, and walks the reader through some common scenarios in which the laboratory’s actions make a difference in diagnosis and treatment.


The author of that article, Lisa Esposito is an RN by training and in an email to me she reminisced on how, as a nurse, she often waited anxiously for critical lab results or blood for a transfusion. “Without the work you do, we would have been at a standstill in patient care," she says.


Articles like these are far too rare. Sometimes it takes others to remind us of our value. Please share with your friends.

Happy MLK Day
January 17, 2015 3:37 PM by Glen McDaniel

Martin Luther King Jr.  was born in Atlanta, Georgia on January 15, 1929. Best known as "the slain civil rights leader" his mission was fighting for civil rights through nonviolent means.  His birthday is now a federal holiday celebrated in all 50 states, although with some reluctance, on the third  Monday in January. This year it will be observed on Monday the 19th.

MLK's life was one of service and in recent years the emphasis has been on celebrating the holiday through some act of community service.  The idea, as someone said, is to have " a day ON and not simply a day off."

Our profession is by definition one of service. It is no surprise that on Monday, while many Americans will be celebrating a day of rest and relaxation,  many of our colleagues will be at work providing healthcare as we do 365 days a year, 24/7. But for those who will not be working, what will you be doing? This is a perfect day to volunteer to help someone less fortunate or who can benefit from your expertise, knowledge; or even your physical effort.

Service is always about the other person, not us, but it is still an opportunity to teach others who we are and what we do. I have met many friends and professional contacts through volunteering, which is something I enjoy and feel compelled to do.

A simple pleasantry like "Where do you work?" or "So what do you do?" is always an opportunity to educate and to advocate for the profession.

The primary function of service is to GIVE, but one can always do well (and derive some benefit) even as one does good.

Whether you are at work or not, I urge you to make this MLK Day a day "on" and not a day off.

What Has Happened to the DCLS Degree?
January 11, 2015 5:12 PM by Glen McDaniel

 For several years now there has been talk about a doctorate in Medical Laboratory Science (DCLS). This idea was advanced by ASCLS to support the idea that medical laboratory science has a unique, distinct, significant body of knowledge that MLS practitioners  should be able to practice independently as do other professionals with similar education and training.


ASCLS developed and published a substantial toolkit which serves as a reference for educators wanting to craft and offer a DCLS program. Professional groups worked with NAACLS, the agency that accredits MLS programs, to develop standards and guidelines for accreditation of DCLS programs 


In recent years many professions that contribute significantly to patient care have asserted their right to have their own doctorate, with pharmacists being the most well-known non-medical “doctor” in the healthcare setting. Others like physical therapy have also advanced the idea of a doctorate as an entry level practice degree.


Despite the hard work that has gone into floating the idea of a DCLS, very few schools have made the leap to actually offering such a degree and enrolling students. I suspect it might even be difficult to convince universities to  authorize a new program without a clear return on investment for the university.


I think there are several reasons for this lackluster response to the DCLS:


-Many MLS practitioners still think of themselves as “only techs” and do not believe there is a viable option for advanced practice or a more significant role in health care for “lab techs.”

-The contents and goal of a DCLS curriculum are not clear. Even those who support the idea of a DCLS describe the ideal program in several very different ways. Will a DCLS focus on clinical research, advanced practice, clinical consultation, directorship of a medical laboratory? All of the above? Will there be the option to specialize in one area, as pharmacists often do, for example?

-With no clear or reasonable assurance of a niche in healthcare, few want to expend the time and finances involved in completing a doctoral program

-Neither healthcare administrators nor pathologists are advocates of the DCLS role. Healthcare administrators are concerned about increased labor cost, while pathologists might fear competition and usurpation of their role as “the lab doctor.”

-Entry requirements for DCLS programs seem very rigid. One program says “Only those with an MLS(ASCP) will be admitted.”  A successful program, especially one that is largely experimental should be more flexible, offering online options, allowing specializations and so on. This can be done while maintaining academic rigor. Just look at the flexibility of many advanced practice nursing programs.


While I continue to be an advocate of the DCLS idea, I feel more needs to be done to clarify the role, to market the benefit to employers and regulatory agencies, and to make the degree more attainable.


It is unlikely that the DCLS will catch on as a first professional degree (as the MD or PharmD) needed to enter the profession.  If folks balk at the idea of professional licensure (for professionals who already meet the requirements for licensure) they are unlikely to go for a higher entry-level degree.


The DCLS is much more likely to be an advanced practice degree, gained after a first degree (and some experience) where the practitioners assume roles over and above that of the “typical” bench MLS/MLT. The question remains “What roles?”


The DCLS is unlikely to gain popularity until that question is answered satisfactorily and all the players (MLS practitioners, clinicians, employers, regulatory agencies and even the public) can see some benefit for themselves.

Know the Difference Between Cost and Value
December 31, 2014 2:38 PM by Glen McDaniel

In casual conversation we use the terms cost, price and value almost interchangeably. That might seem to be just semantics, but I think we send mixed messages or act inappropriately when we start believing these concepts are identical.


Anyone who has a teenager probably knows all too well how they are guided by peer pressure. All the girls tend to wear the same fashion. Young people of both genders hanker for the latest “trendy” shoes, gadget or new toy. To many the cost does not matter and the sellers (knowing the demand) over-charge accordingly.


A friend of mine told me his  son who is unemployed borrowed $200 to acquire a pair of sneakers because they were the “it” shoes of his generation. I have driven a luxury car for the past few years but as it aged the repairs became never-ending and very expensive. So I traded it in for a sturdy, dependable Japanese car and am shocked at the many comments I have received. You would think condolences are in order because I have been “reduced” to a non-luxury car with much less status.


OK, so that gets me back to the various terms I started this blog with. I am writing this not only because of recent experiences, but because I believe they have significance to all our personal lives and also our professional lives. How do you value yourself, your colleagues and your profession?


Let’s just define those key terms simply, instead of using the formal economic definitions.


Cost: is whatever is spent to produce goods and services. So it might be what Toyota spends to make a car, how much Apple pays a worker in Asia to make an i-phone, or how much your employer is out of pocket to have you work for them (recruitment, salary, benefits etc).


Price:  is the what is charged or received by a seller. Again, using the car/employer analogy, it’s what someone pays the dealer for a Camry, or what your employer pays you to do a job as a phlebotomist, MLT or MLS  for them.


Value: is whatever the customer believes a certain good or service is worth. Value is a much more subjective quality, but it is what really drives the price.  The perceived value of "it" sneakers or an I-phone have very little to do with their respective cost of production. You can look at various professionals and realize that pay is not commensurate with education, work ethic, competence, service provided and so on.


My teenaged neighbor was willing to go into debt and pay hundreds of dollars for a pair of sneakers because of the value he assigned to those shoes. Employers will pay certain employees more because of their perceived value in the organization.


We tend to regard anything with a high price tag as being valuable, or more significant and important. The converse is also true: if we can convince a customer or employer that we are valuable, important, critical, crucial to their success, then our value increases.


These might appear to be subtle differences, but not knowing the difference often results in being undervalued and underpaid.


Here’s to recognizing and explaining your value (and fetching an appropriate price) as you move into the New Year

Expand Your Network by Bridging Structural Holes
December 28, 2014 3:30 PM by Glen McDaniel

Think about the people you know professionally; and most likely the majority are also laboratorians. That seems logical because you interact with colleagues at work. Maybe you belong to a local professional group or even a national membership organization. You might even know the majority of medical laboratorians in your city. That makes sense.


But think for a minute about the many professionals you know who may help in your career or who you can use as a resource from time to time.


Research conducted by Ronald Burt at the University of Chicago School of Business finds that our personal and professional lives are richer and more productive if we build bridges with others who are different and with whom we would not normally interact. This is called bridging structural holes.

Certain individuals and groups seem naturally connected to certain others; often comparing similarities and exchanging thoughts, ideas and even support. Burt says social capital, on the other hand,  is created by brokering connections by otherwise disconnected segments. All parties benefit from this symbiotic structure.


By the way, this is not the same as networking which is a deliberate strategy of expanding your list of contacts so that you can call on them periodically if needed.


You can deliberately bridge structural holes by creating associations outside of the laboratory: in your organization, at church, in a volunteer organization and even online.  Sometimes  it takes someone with different experiences and frames of references to bring a new perspective. They can identify strengths, weaknesses and even holes in your logic that you cannot see. In return you can garner support and even borrow ideas of how to solve a problem you are grappling with.


The great thing about bridging structural holes is that it is mutually beneficial. Many processes or lines of thought which are traditionally connected with scientists can be beneficial to those in business, social science and other areas. The reverse is also true. I cannot count the many times I have been complimented on my ability to analyze complex material or  my keen attention to detail. These traits come naturally to scientists, but not necessarily to my friends in business, some clinical disciplines or even journalism.


 When you adopt (or adapt) someone’s ideas you don’t even have to tell them, and you can avoid the sense of obligation of having to constantly ask for favors.


Here's the take-away. Deliberately court relationships with others “not like you” and observe how they think, the logic they use, they tools they have, the resources they draw on. Learn from them as they learn from you.


Chances are you will find something useful that will benefit you in your personal or professional life.

Time to Reflect on 2014 and Plan for 2015
December 26, 2014 12:36 PM by Glen McDaniel
The year is winding down and it is traditional to start looking forward to the next year. This is the time of year when we traditionally start thinking about what changes we will make in the New Year.


Some have already started penning their New Year's Resolutions. May I suggest that before you jump into crafting the year ahead, you review the current year. Get pen and paper and be brutally honest. It might take several sessions. If necessary, leave your list and come back to it after some hours (or a few days) of contemplation and memory recall. Analysis of personal and professional successes and challenges often come up with similar issues; a theme if you will.


What worked well? What did not? What issues kept popping up? What challenges were there? Those should be the areas on which you focus your attention. Is there a theme? You might find, for example that both personally and professionally time management or life balance were challenging. If so, how can you commit to doing things differently in 2015?


I am not a big advocate of lists or promise-to-do resolutions. I have blogged about those previously.


Since areas that we want to work on or goals we want to achieve tend to have a theme, I suggest (as I did last year)

that we concentrate on a vision for the new year.


Holding that one grand idea helps to focus attention and keeps you in check as you  measure significant actions against that vision, “Will  this action (move, job, school, relationship, expenditure etc.) move me closer towards my grand goal or not?"


I received scores of emails from individuals who have found this concept useful, so I submit it to you as well.


Here’s wishing you a very happy, prosperous and successful 2015, and please share your insights and successes with us!

Person of the Year: The Medical Laboratorian
December 21, 2014 1:48 PM by Glen McDaniel

As we come towards the end of the year several publications generate lists, perform annual reviews and select the most newsworthy items for that year. One eagerly anticipated “contest”  every year is the Time Magazine Person of the Year (POTY).


This year Time chose “The Ebola Fightersas their POTY. “They risked and persisted, sacrificed and saved,” says the preamble to the declaration. They even waxed poetic by adding, "Not the glittering weapon fights the fight, says the proverb,  but rather the hero's heart."


I totally understand this choice given the focus on Ebola this year, and the fact that for the first time in the history of the disease Americans were affected in a real way. It is human nature to attach more importance to matters that affect us than those that occur far away.


However, if the POTY needs not be one individual, and if the honor is to recognize those who have made a real impact on the world, then I nominate (and select) the Medical Laboratory Professional.


These professionals-scientist, technician, specialist, pathologist-work  tirelessly all year to be medical detectives, ferreting out the cause of disease, monitoring the effectiveness of treatment and helping to maintain health. This might not be a showy endeavor that makes the news, or even attracts the attention of patients and other healthcare providers, but it is vitally important work. In fact it is essential.


I suggest that the real heroes are those who not only perform yeoman duty every day, but continue to do so despite the lack of public recognition or even compensation commensurate with the value they contribute to the public’s health. It is not the "glittering weapons” of analyzers and “toys” in the laboratory, but the talent, competence and heart of the laboratorian that really make the difference.


Like everyone else I read the annual lists and honors, but I choose to salute you, my fellow laboratorians, individually and collectively, as The Person of the Year!


Soon an Entire Lab on a Chip?
December 11, 2014 10:29 AM by Glen McDaniel

Bigger is not always better, it turns out. It seems our appliances, gadgets and instruments are getting smaller; or at least coming in smaller versions, even as they have more capability.

I was watching an old crime movie this past weekend and burst out laughing when a detective pulled out a cell phone the size and shape of a brick. That was state of the art technology in communications back then. Over the years cell phones have gotten smaller even as their sophistication has increased. The typical smart phone is not just slim, but has the memory and capability of a full size computer. In fact the cell phone in your pocket most likely has more computing power than the computers that first put man on the moon.

The entire Point of Care Testing (POCT) arena has been growing by leaps and bounds as many tests traditionally performed in the laboratory on large, complex instruments can now be done on small black boxes or test kits close to the patient.

One new development in the news is that of what has been dubbed by some the Theranos Miracle. California-based startup company Theranos under founder Elizabeth Holmes is threatening to revolutionize the field of medical laboratory testing. Theranos has developed a proprietary phlebotomy process that is self-described as “a painless micro-needle that draws a few drops of blood, enough to perform 70 assays per sample.” 

The company is now offering blood draws in Walgreen pharmacies, offering not just convenience, but patient comfort and fast turnaround time. But lest you think this is just a small niche market, or that the claims of revolution are hype, look at the following

- The Theranos lab in Palo Alto is CLIA certified

-They are highly capitalized with millions of venture capitalist dollars

-They intend to expand nationwide

- They want to act as a reference lab for smaller labs and even larger hospitals by being competitively priced, offering a large menu, small sample size and rapid TAT

-They use cutting edge testing technology like ELISA and nucleic acid amplification

-They are in the process of obtaining FDA clearance for all of their tests

-They are highly computerized, so there is positive identification and specimen tracking from collection all the way back to the ordering provider

Laboratorians traditionally love technology. But here is a development that could revolutionalize the way we practice-and even who performs testing.  How do you feel about this sort of new development?  We have seen that technology tends to grow exponentially rather than incrementally so ventures like Theranos are likely to become more common with more bells and whistles pretty fast. Technology tends to be exponential, even as organizations change more slowly or logarithmically. Will your organization be ready to capitalize on this sort of modified lab-on-a-chip?

 Do you feel threatened in your role as a traditional laboratorian and how do you think these changes will affect the profession as a whole?


Happy Thanksgiving to You
November 24, 2014 1:03 PM by Glen McDaniel

In a few days the country will be celebrating Thanksgiving,but this festive holiday means different things to different people. To many it will be a day off from work, a time to spend with family, to over-eat and drink too much. It will be a time when family members get to show off their favorite recipes, critically assess relatives they haven't seen all year and, if lucky, enjoy a long weekend. To others it signals the start of the Christmas shopping season and an opportunity to start eagerly stimulating the econmy!

It is pretty easy to forget how Thanksgiving started as a celebration of a successful harvest by the Pilgrims, that over the years there have been different days of thanksgiving based on historical milestones, or  that the day itself was not always a permanent national holiday.

Many incorrectly think of Thanksgiving as a uniquely American holiday. I once mentioned to a colleague that I  was headed to Toronto to celebrate Canadian Thanksgiving with family and friends. I told him the celebration was on the 2nd Monday in October.  He replied in utter consternation, "Why do Canadians celebrate Thanksgiving? What are they grateful for and why are they celebrating on the wrong day?"

So the idea of giving thanks on a particular day has a checkered history; but reduced to its basics, it is a time to be grateful for all the blessings we have individually, as a nation, as a family, and as a profession. It is formal recognition of the gratitude we should feel all year long.

As a profession we should be grateful for the opportunity to serve, the ability to make such a valuable contribution to the health of this great country. We have a long way to go in terms of  recognition (pay, independent practice and licensure, for example) but we have also come a very long way, especially technologically.

While many can kick back and enjoy a long weekend of feasting, fellowship and foootball, many of you, my colleagues, will be away from family and friends; working as you do all year long. You will be supporting the health of the country. For that, I am personally grateful. You will be using your expertise, competence, knowledge and critical thinking skills to make crucial decisions that often mean life or death. For that, I am immensely grateful.

Whatever you are doing this Thanksgiving and however you choose to celebrate it, enjoy it and be safe. And, please take  a moment to acknowledge those achievements, qualities, individuals and blessings for which YOU are grateful.

Happy Thanksgiving!

Has Ebola Suddenly Gone Away?
November 15, 2014 6:03 PM by Glen McDaniel

Just a few short weeks ago, Ebola was the talk of the town. Both the lay public and healthcare professionals seemed consumed with the topic. Entire cottage industries were born to supply Ebola-proof personal protective equipment (PPE) and to teach Ebola safety.


There was a CDC conference call almost daily to update (and modify) guidelines. Hospitals diverted lots of resources to train their staff and to provide PPE in emergency departments and many patient care areas. The nation’s largest airports started screening visitors originating in Western Africa.


Several very enterprising merchants ramped up production of Tyvek-looking full body suits in time for Halloween.


Now, Ebola is rarely even mentioned-at least on the online sites that I visit and the healthcare organizations that I work with. So what happened?


First, the cases in the USA seem to have got less and those being treated in the US (except in one Texas hospital) have all had favorable outcomes. They were all released, essentially cured.


Conversely, why the earlier panic? Again it’s conjecture but there are several possibilities:


-This decades-old disease was now infecting Americans so it suddenly became new, serious, significant and important to Americans

- The media pushed the fact that it was largely fatal, and as much as they explained how it was spread through intimate contact with body fluids, the public chose to concentrate on the fatality rate and the fact that PPE use as described  by the CDC might not be 100% fool-proof

-There was an election looming and this was too tempting a drama not to exploit for political purposes. Who would be best at coping with this “foreign disease?” How tough should sanctions be: travel bans? Quarantine? What would each candidate do to protect you?


Now the election is over, the US has an Ebola-czar and there are currently no patients being treated for Ebola in the USA. So Americans have tended to turn away as if bored with a prime time melodrama and its drawn-out plot.


But the battle continues elsewhere. According to the World Health Organization (WHO) more than 14,000 have become infected and over 5,000 have died since the 2014 Ebola outbreak in March.


One doctor infected in Sierra Leone is on his way to be treated at the Nebraska Medical Center’s Biocontainment Unit, which  like Emory University in Atlanta and National Institutes of Health have a perfect record of treating patients using appropriate infection control protocols and targeted treatment by dedicated medical lab scientists, doctors and nurses.


There are 3 principles that come to mind. In healthcare, actions should always be based on science. We should be concerned about healthcare issues regardless of who is affected. Finally, healthcare delivery should not be politicized or overdramatized for political reasons. The Ebola scare is instructive because the public reaction violated all 3 rules.


This is a shame.

You Work for Yourself, No One Else
November 9, 2014 7:39 PM by Glen McDaniel

My dad was so proud of the fact that he worked for the same employer for 40+ years. He was never late, was rarely sick and sometimes went to work despite the fact he was under the weather. He thought he was indispensable and that his employer really valued him. To him loyalty to one employer was huge.


He received a small pension - not even the metaphorical gold watch, or a cake and punch party - when he retired riddled with aches and pains.


How things have changed. It is now very clear that employers have no loyalty to employees who are typically viewed as “elements of production” and therefore costly and replaceable.

Several years ago, the American Management Association (AMA) conducted a survey of 6,000 participants across the United States. The survey asked employees 2 questions:
1) Do you get enough recognition at work?
2) Would you do a better job if you got more recognition?

There was no equivocation in the answers.   Over 97% of the respondents said "no" they didn't get enough recognition at work, and 98% replied "yes" they would do a better job if they received more recognition. This means that employees think recognition is very important, but that they don’t receive nearly enough from employers.

The typical employee (inside or outside of healthcare) will have several jobs in their lifetime, sometimes even changing professions.  Laboratorians are no exception and have come to realize that employers have no loyalty to them, and will gladly cut an employee loose for a variety of reasons including preserving the bottom-line.

That does not mean that the employee-employer relationship has to be adversarial. However it is important to realize that you work for yourself first and foremost.  In every job you should learn as much as you can, develop new transferable skills and keep your resume current. Consider a reasonable work-life balance.

A flexible, nimble employee is a good employer of him or herself. To be a good self-employer, you should be open to change, cross training, taking on new projects and practicing constant networking. Learn as much as you can, and acquire skills that no one can take from you. Position yourself as a valuable individual professional, not merely as an employee of ABC Laboratory.  It is easy to get comfortable in a job, but at least once a year, update your resume with any new skills you have acquired. Look at job ads and decide, in an ideal world, which one would you go for. Practice writing a cover letter. List the professional colleagues you would like to act as your professional reference if necessary.

This exercise is as much a matter of psychology as practical preparation. If you suddenly have to make a change (voluntary or not) you will have a leg up if you are prepared, sale-able and have a current resume.  Faced with change, you will then have real options to make the move that is right for YOU. Your employer will be OK and will move on without you.  Trust me.



About this Blog

Keep Me Updated