Not Ready For Prime Time
Last year I asked for an early proposal to upgrade our chemistry analyzer because of method performance. The physicians will like better low-end precision, I reasoned. But the ED director said, “I don’t think that’s quite ready for prime time.”
I’ve heard this response many times in my career. Other examples include prealbumin, C-reactive protein, and H. pylori antigen testing. There are those tests and methods that look great to the laboratory; they have higher sensitivity, higher specificity, and greater accuracy. For whatever reasons, all physicians aren’t ready to order them.
The flip side are those tests with poor sensitivity or specificity and lousy accuracy that they keep on ordering. Ditching the venerable ESR, for example, is an idea still not ready for prime time, despite considerable support in the literature to replace it with CRP. Others are CKMB, peripheral smear band counts, bleeding times, and tests that seem, at least from a laboratory science perspective, to be outclassed by newer, better methods.
- We perform the testing but do not bear responsibility for making treatment decisions. Unless a test is really not indicated or obsolete e.g. Lee-White clotting time, it shouldn’t make any difference to the techs at the bench.
- We have an obligation to educate providers on the advantages and application of newer and better tests, keeping in mind the above. Unless a test comes along that measures something previously unavailable, some physicians will continue to order same old, same old.
It’s easy to confuse the two. Sometimes it’s possible at the point of service to inform a physician about a newer, better method, and sometimes he or she will ask. But many times this kind of approach will aggravate the physician or make it seem as though the lab is reluctant to perform the testing. The worst situation could be giving an impression of questioning judgment. At least, it’s very poor customer service.
But there’s plenty we can do instead of griping. Next, I’ll consider a few ways to be proactive in promoting laboratory services.
NEXT: Sell Your Lab