Let me explain – I’m not that crazy

OK, so I’ve had quite a few messages from some of you regarding one of my recent posts where I said that it was the fault of the medical laboratory that the physicians are asking the laboratory questions to the pharmacists.  So much that I felt I needed to explain this position a bit more.

First, let me just say that any generalizations that are made here will not apply 100% of the time.  Just like every algorithm will not apply to every single patient every single time, a generalization will not apply every single time.  There are exceptions to the rule – or observation.

I recognized many years ago that there was this gap between the laboratory and the physicians; and I believe that the vast majority of laboratory professionals would agree that this gap exists … OK, maybe not the pathologists, but I’ve met several pathologists that admit it does exist.  The problem, however, has been what should we do about this gap?

When I first started researching the DCLS I was so disappointed in the negativity that was being posted about it by members of my own profession.  At first I thought “these are just negative ninny’s hiding behind a keyboard that are so unhappy they just want to shoot down anyone else’s idea on how to fix things”.  OK – so that wasn’t a direct quote of my thought process … there might have been a colorful metaphor or two in there as well.  But then I started to discuss the idea of the DCLS in person with other laboratory professionals and the vast majority of the response was disheartening.

I had very few fellow laboratory professionals that believed in the prospect of the DCLS.  The vast majority were very negative.  Reasoning that I was given for their beliefs included:

There is too much bench work so why would they hire a DCLS?

They won’t pay us because they don’t have any money why do you think they are going pay someone who isn’t working the bench?

Everyone outside of the lab thinks we are button-pushing monkeys and they aren’t going to treat us any different.

Nurses hate us; trying to explain anything to them is a waste of time.

That is the pathologist’s job, not ours.

(My personal favorite) Our job is to provide the data. It is the physician’s job to order and interpret. It’s their fault if they get it wrong.

It was very troubling to hear all of this from my fellow laboratory professionals.  But, as my core knowledge grew, I started answering the questions of the physicians anyway.  And guess what happened?  The physicians appreciated it.  They wanted more!  More and more physicians that I came in contact with wanted my help.  I have only come in contact with one physician that point-blankly told me that he didn’t need my opinion on anything (he was also 85 years old and practiced medicine like it was 1970 so I’m not surprised).  Nearly every physician I have come in contact with has been appreciative and welcoming of this type of laboratory consultation.

Unfortunately, we have neglected this for so long, and the physicians have been yearning for help with laboratory test ordering and interpretation.  Physicians are also, generally speaking, not very patient and want instant gratification.  So when they have had a question about laboratory testing, they began asking the only person in front of them that could possibly answer their question: pharmacy.  From the clinical pharmacists that I have spoken with, they are fairly comfortable with some test interpretation such as microbiology sensitivities and therapeutic drug levels, but were unsurprisingly uncomfortable when asked about appropriate specimens, test methodology, etc.  But the physicians were looking for someone … anyone … to help ………………………………… and we were not there.

Now, there are some techs and some departments in select few facilities that have made themselves into the “problem solvers” for the physicians.  This is usually either the microbiology or send-out departments.  Microbiology makes perfect sense especially in working hand-in-hand with Infectious Disease physicians.  Send-outs is usually to help curb the insanely expensive esoteric test requests from interns and residents – July 1st is just around the corner! 🙂

I applaud these techs and the effort that they have put forth in being that voice that the physicians need.  But it is not enough.  These are reactive consults: waiting until the physician brings the problem to them.  We need to be proactive in our consulting.  We need more DCLS’s training in the programs.  We need more DCLS’s on the floor with the physicians.  They want our help.  They need our help.  I’ve been in two different states and in different types of facilities and trust me: they want our help.

We just have to be able and willing to give it.

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11 thoughts on “Let me explain – I’m not that crazy

  1. I whole-heartedly endorse and applaud everything you just said!!! In my own experience, physicians are SO THANKFUL for someone from the laboratory who is a resource to find answers for their questions. I have done this myself for years, and have been blessed to be a resource to the physicians who are taking care of some of the most critical patients in the hospital. I have experienced the exact same negativity from almost everyone I encountered, including my own management. I have experienced great thankfulness and appreciation from the physicians who discovered they had someone to call and who was knowledgeable and willing to help them find answers. Here is my analysis of what has happened in the laboratory. When DRG’s came into play, Pathologist (who I have great respect for), walked away from Clinical Pathology – with rare exception. Why? Because they do not get reimbursed for anything in CP, like they would in AP (Anatomic Pathology). I can’t blame them…. no one wants to work for free. As the years went by, technology has changed tremendously, and the older Pathologist have retired. Now, we have a situation with new testing and technology that is exploding onto the scene with logarithmic speed. There is a desperate need for someone with a solid background in the Clinical Pathology Laboratory, who has a strong understanding of basic concepts, but who can also research and adapt to the exploding plethora of technology that is occurring. Physicians are bombarded with new and rapidly changing protocols, demands for electronic documentation, etc., and they cannot be expected to keep up with changes in the laboratory. WE own the data and technology in the laboratory. It is OUR duty to understand it, monitor the appropriate utilization, and appropriate interpretation of that data. Great job Brandy!!! I am SO excited, and SO happy for you!!! You get it in a way that is trail-blazing. I predict that you will soon need to clone yourself.

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  2. Not to sound like a negative ninny, but yes, of course, the physicians appreciate free help, as in I am assuming you are helping them as part of an internship that bears no cost to the receiving institution, but I wonder exactly how many would actually pay for the same services, especially during today’s healthcare crisis. I am reluctant to rely on employment estimates from educational institutions whose numbers may be inflated to make their programs appear more promising. I’m not implying that you’ve not done your homework in this area, either. These are just questions that came to mind as I read your commentary.

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    1. Monica – your fears are not unfounded! I had people that told me I was crazy when I started because there was no guarantee of employment afterward. I ventured forward on faith because I knew that it was needed. Thankfully I have already had multiple offers for employment for when I graduate. While I think that, at least initially, the DCLS will be more attractive to teaching facilities and smaller hospitals that do not have on-site pathologists, I foresee a future where there are DCLS’s that are nearly as prevalent as clinical PharmDs. Just like clinical PharmDs, the value in the DCLS is measured in cost savings and improved patient outcomes. Thanks for the comment!

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  3. Part of the issue is that we are viewed as no bodies off the street that push buttons. The doctors don’t know or care that we are highly trained. A lot of the time I feel our diagnostic knowledge is more advanced but that also depends on the doctor. But this disregard for our education means they don’t want to listen to us. Even at the expense of the patient’s health/safety. And if your pathologist doesn’t have your back then its even harder to earn respect. I love what you are doing. Shedding light on us. Making it better for us and patients. Keep up the good work

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    1. Jennifer – I agree. I, too, have been on the receiving end of comments from physicians and other healthcare professionals that have no idea our education. I hope that the more we have a face outside of the laboratory dispelling these myths about laboratory personnel, the better it will be in the long run. Thanks for the comment!

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  4. Brandy you are giving me hope for the future. I retired last year after 39 years of loving the profession but hating what was happening to it. As technology has become more complex the idea is to hire a less educated person and pay less to have them crank out results. In reality more tests and higher complexity should require more educated workers! Most physicians really appreciate the help. Once they find a “go to” person in the lab they will call and ask for that person to answer questions. I was one such person. If I didn’t know the answer I would research it and get back to them. One of the problems is that lab people are a tad nerdish and therefore tend to be socially backward. These types typically cannot be bothered to even answer the phone. They don’t feel it’s their job to be social, which is why they are in the lab to begin with, to avoid people. We are the only ones who can change this by speaking up and through education. Any laboratory would be thrilled to have you.
    Keep on keeping on😃

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    1. Gail – The DCLS is not for everyone. In my experience, the vast majority of pathologists went into pathology because they loved medicine but didn’t care for patient contact … at least alive patient contact. I think this is also true in the medical laboratory – and that is OK. We need people of all types to make the lab work. But we are also all on the same team. Once we are all working together, both inside and outside the laboratory, I think we will start to see major improvements. Thanks for the comment!

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  5. Hi Brandy. This is more of a question than a comment. From your experience, what states have you be in that are looking for DCLS professionals? I have spoken with quite a few lab professionals (lab directors, pathologists, other med techs) in my state thus far (Louisiana), but it seems like they don’t see the need for a DCLS. As a new med tech, I still have some time before I would qualify for a DCLS program, and I wanted to know where should I begin to searching for employment prospects?

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    1. Patrice – Thank you for your question. First, you are talking to the wrong people. As I have mentioned in my blog, I have had more push back and negativity from our own profession and within the laboratory community than outside of it. Talk with the non-pathologist physicians and ask: would you want someone to round with you that was like a clinical pharmD but was a specialist in laboratory diagnostics and interpretation? I am from Louisiana and one of my offers is from Louisiana so it is not the state, it is who you have talked to about it. I am not sure why there is so much negativity and reluctance from the laboratory community. The pathologists I can sort of understand because they may think we would be stepping on their “territory”, yet the vast majority of the pathologists neglect clinical pathologist consultation and clinical pathology in general. Virtually every non-pathologist physician I have encountered wants a DCLS rounding with them just as much as they want a clinical pharmD rounding with them.

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