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.