Anyone who has spent any significant time in a medical laboratory, whether it is as a phlebotomist, lab assistant, MLT, MLS, or PhD knows there is a major problem that has been largely unrecognized by the physician community: the improper utilization of laboratory tests and … the misinterpretation of those tests. Us in the laboratory have historically been told that this problem is none of our business; our job is strictly to turn out the test results that as they are requested without question and what is done with those results is beyond our responsibility. Unfortunately, this thought process by our own profession has resulted in hundreds of thousands, if not millions, of patients yearly having the wrong test ordered, or the right test done at the wrong time, or the test results being misinterpreted all resulting in either misdiagnosis and/or wrong treatments.
After Hurricane Katrina hit New Orleans, I relocated to Northwest Louisiana and eventually ended up managing the laboratory of a large family practice clinic and urgent care. I was able to build a working relationship with the physicians to where I started to question certain test ordering practices. Some of them were questions regarding the wrong test: like ordering a Factor V Leiden for a patient with epistaxis (that’s nose bleeds for the muggle folk) or ordering a Hepatitis B core antigen when testing a patient for immunity [Factor V Leiden is for clotting issues not bleeding and the correct test for checking a patient’s immunity to Hepatitis B is a Hepatitis B surface antibody]. Some were where the test that was needed was missing like a urinalysis to evaluate a slightly elevated PSA or a BNP when a patient had signs and symptoms of congestive heart failure. Others were ordering tests at the wrong time such has ordering a progesterone to test female fertility without documenting what day of her menstrual cycle she is on. Ultimately it was still up to the physician to decide what test they wanted. Often times they would change the order. Occasionally, they would not. I presented them with the evidence in the form of case studies and research on why I was suggesting certain test order changes.
Guess what happened?
They appreciated it. Not only did they appreciate it, they wanted more. Additionally, I realized that I really enjoyed helping them. The more I assisted them in proper lab utilization I quickly realized that I needed a larger skill set to address the more and more complex issues they were asking of me. This is when I did what everyone else does when they want to answer a question: I Google’d it.
This is when I found the ASCLS position paper on the Doctorate of Clinical Laboratory Science. OMG – this is what I want to do! This is exactly what is needed to address this rampant problem in laboratory medicine! I knew then that the DCLS is what I wanted to pursue. I also came across some names that led me to the master’s in MLS program at the then University of Medicine and Dentistry of New Jersey. While there were no DCLS programs in existence at that time, UMDNJ was on the “radar” as potentially having a program in development. Figuring that I would need the master’s degree to get into a DCLS program, I applied and was accepted in their master’s program.
This was where I began to obtain the skill set necessary to begin answering more complex questions.