Stepwise Success

Rules and Algorithms

2009-11-06T11:26:00Z

Just the other day a question of how to alert physicians of laboratory reflex rules came up. After all, everyone's rules are slightly different. Examples: if the dipstick is positive for blood or leukocyte esterase, perform a microscopic examination of urine sediment; if the triglycerides are elevated, perform a direct LDL cholesterol measurement; if a screen for unexpected antibodies is positive, perform an antibody identification. These "if-then" rules are simple enough. But many are more complex....(read more)

Weasel Words

2009-11-02T11:26:00Z

Don Watson says in his introduction to Watson's Dictionary of Weasel Words, Contemporary Cliches, Cant, & Management Jargon that weasel words are bringing about the death of language. "The real disease," he writes, "is in the system: in the new models of business organisation, in the triumph of economics. It is there in the cant of competitive advantage and human resources management , transparency, accountability : in the clichés, consumer, client, key, core, going forwards, at the end of the day,...(read more)

Plan, Don't Panic

2009-10-28T10:27:00Z

The other week I watched a show on the Discovery channel in disbelief. Called Pig Bomb , it described hoards of feral pigs roaming the Southeast. Locals may have cross-bred the American boar with its ill-tempered cousin, the Eurasian wild boar, for hunting . A six hundred pound, sixty mile per hour beast with tusks would be hard to shoot, never mind it panicking unarmed civilians. But I wonder if it's all as bad as it looks. And so I ponder swine flu. A threat of unknown impact is always unsettling,...(read more)

Abort Retry Ignore

2009-10-23T10:07:00Z

MS-DOS (Microsoft Disk Operating System) debuted 28 years ago, quickly finding its way into labs on PCs in offices or attached to instruments. Programs such as BASIC promised much. We just knew , deep down, that computers meant less paper, effortless statistics, and (ha, ha) fewer telephone calls. Nearly three decades should be enough time for a technology that doubles in capacity every two years ( Moore's law ) to accomplish all this. But modern information systems generate more paper, telephone...(read more)

Back to BASIC

2009-10-19T10:17:00Z

I once read an article about a BASIC program used to temperature-correct arterial blood gas results. This was in the day when a program could be "keyed in" from a magazine. BASIC, which stands for Beginner's All-purpose Symbolic Instruction Code, was quick, versatile, and loaded on nearly all computers. You may remember this: 10 CLS 20 PRINT "Hello World!" BASIC is an interpreted language, meaning that instructions are read and executed on the fly. It is thus limited by its interpreter, which usually...(read more)

Teachable Moments

2009-10-14T10:25:00Z

Much was made of the President's "beer summit" last July, a meeting between a black professor and the white policeman who arrested him, something the Wall Street Journal labeled a "teachable moment." Aside from wondering what kind of beer goes best with conflict resolution, I'd never heard the term. A teachable moment is that rare and special event in the classroom when a teacher has the ideal opportunity to offer insight and students are most receptive. Teachers are aware of and seize these opportunities....(read more)

Write Thyself

2009-10-09T10:55:00Z

It wouldn't surprise me if most laboratories have more written procedures than all other departments of the hospital combined -- shelves of them in worn, bursting binders. Printed or scanned, that's a lot of writing. And I'll bet the procedures are all comprehensive, detailed, and referenced. CLIA (Clinical Laboratory Improvement Amendments) Sec. 493.1251 describes what procedures contain, beginning with they "must be available to, and followed by, laboratory personnel." It may not be Hemingway,...(read more)

Valuable Work

2009-10-05T11:16:00Z

When a round robin of "What's New" got to me at a recent department head meeting I said, "We're working on a new C. diff algorithm that screens for toxin-producing antigen and not just the toxin." Amid blank stares one manager laughed, " English please!" Such befuddlement is a good-natured acknowledgement that the lab is a technical, even obtuse, department. And while this example is somewhat artificial – I had only a moment to explain what was new – it has a point. If success depends on peer acceptance,...(read more)

Competency

2009-09-30T11:04:00Z

According to CLIA (Clinical Laboratory Improvement Amendments) Sec. 493.1413(b)(8) , the technical consultant is responsible for "evaluating the competency of testing personnel." There are a number of ways to do this: direct observation, review of records, analyzing previously tested samples, and so on. These have to be written procedures (493.1235). But what does this mean? At first glance, more work! It means retesting samples, extra documentation, and being watched. This insults professionals...(read more)

More Bullies

2009-09-25T10:54:00Z

I've written about bullies in contexts of relational aggression and most recently in terms of what it means to you. Let's consider several examples. The Coworker Bully – this individual goes to breaks and lunches before you, volunteers early for the sweet schedule spots, and leaves the hard bench work for you. The Nurse Bully – this individual has been at your hospital for many years. Her manner is scornful and offhanded to the laboratory, and the few times you've talked to her she's infuriated you...(read more)

Bullies

2009-09-21T11:30:00Z

When I was a kid, every grade seemed to have a bully, often a large boy with thick fists who didn't do well in school. Small for my age, I saw many of them up close. I was told to stand up to bullies -- essentially cowards -- or suck it up. (I got larger friends.) Schoolyard bullies, it seems, eventually get jobs. According to a recent story , almost 50% of American workers have been bullied or witnessed a coworker being bullied. The Workplace Bullying Institute defines the behavior as: Verbal abuse...(read more)

The Box

2009-09-16T11:28:00Z

Along with "Aha!" moments – those insights that punctuate hard work – you've probably heard the idea to "think outside the box." It means to think from an unconventional or different perspective, assumed to be essential in creativity. It's a cliché these days. I'll tell a story. Twenty years ago I worked in a laboratory facing a budget crunch. Our manager held an emergency meeting and explained our situation in grim terms. Unspoken was the elephant that payroll is easiest to cut. Instead of rallying...(read more)

Take Home the Aha!

2009-09-11T10:21:00Z

One of the catch-phrases at seminars is The take home message is… Giving your audience a pithy "take home" message is good public speaking. It can be a memorable way to summarize an idea, merge ideas with action, or put a complex idea in terms everyone remembers after the seminar. The take home message is the punctuation at the end of the speaker's communication. Example: no magic bullet. But does it change thinking? The "Aha!" moment does that. This happens when material is presented in a way that...(read more)

Calculations

2009-09-08T10:17:00Z

Most of us aren't mathematicians. Well, I'm not. I've known people who are just better at "seeing" math than myself. I've always struggled to add a column of figures in my head, forget solving Fermat's Last Theorem . Which has been solved already. Just as well. Even so, some formulas are burned into my layman's brain from repetition. Creatinine clearance , expressed as mL/min cleared and often corrected for body surface area, compares the level of creatinine in the urine with the level in the blood...(read more)

Package Inserts

2009-09-02T10:14:00Z

In writing a procedure, I strive to make it the reference on the bench. Yet no matter how good a written procedure is, the package insert is always invaluable. There are two reasons for this. One, the package insert is the main reference for any procedure and should be consulted to resolve questions. This can be useful if information changes, for example. Two, there are details in the package insert that may not be included in a stepwise procedure meant to standardize performance on the bench. I'll...(read more)