Clinical Laboratory Professionals—It Starts with You

By Fred Rodriguez - March 16, 2021

CV April_Rodriguez

A patient goes to the doctor with symptoms and a complaint. The doctor listens, and believes he knows what’s wrong with the patient, but how does the doctor turn a belief or perception into knowledge or “truth.” The doctor needs objective facts or measurable data. He needs more than just an opinion to prove a diagnosis.

Clinical laboratory test results are the objective facts or measurable data that make the difference. That’s where the clinical laboratory scientist, the medical laboratory professional, comes in. The correct diagnosis and the subsequent appropriate treatment the patient needs depends on, and is driven by, the right lab test results, at the right time, for the right patient.

As medical laboratory scientists, the knowledge and skills you have acquired in your training, and the experience you will accumulate in practice, establish that what’s right for the patient starts with you.

Most doctors, nurses, and patients, do not know or understand how lab test results happen. The principles of laboratory testing are not part of the usual curriculum of medical or nursing schools. Any test result, from any source (eg, point of care, patient self-testing, the main lab, etc) is thought to be equivalent. Quality control, proficiency testing, test validation and verification, and all of the other quality management processes, which are standard in an accredited, well-run lab, are out of sight and out of mind of anyone who is not a laboratory professional. It is likely non-laboratory professionals will not appreciate the knowledge and skill you have. You might not even be considered a “professional,” but I’ll talk a little later about how to gain appreciation and how to substantiate your place on the healthcare team.

Be meticulous

Quality lab test results demand attention to detail and scrupulous adherence to standardized procedures. Non-laboratory professionals have the perception that, with modern lab instruments, testing is all automated. All you have to do is push a button and voila, accurate test results appear. Getting the right lab test results, at the right time, for the right patient is hard work. Deviation from standardized procedures introduces variance, and variance results in erroneous results and poor healthcare outcomes. Never compromise on quality control, proficiency testing, test validation and verification, and all of the other quality management processes that are required for accurate and precise lab test results.

The only constant in life is change

New technologies, new instrumentation, and even new diseases are constantly emerging. How you have been taught to practice laboratory medicine today will not be the way you will be practicing laboratory medicine five or 10 years from now. You will have to continue with lifelong learning to constantly update your knowledge and skills. The requirement to keep current is likely to be a condition of employment. Failure to keep current may result in you becoming unemployable. Maintain your certification.

Share your knowledge—Teach

There is no better example of the lack of understanding, and the misinterpretation of lab test results by most doctors, nurses, and patients than current COVID-19 testing. RT-PCR, antigen tests, and antibody tests measure different analytes. Complicating things further, there are multiple different methods for each analyte. Each different method has different levels of accuracy, precision, sensitivity, specificity, and predictive power. The outcome is that the interpretation of COVID (and many other) lab test results by doctors, nurses, and patients is fraught with misunderstanding. Remember, non-laboratory professionals believe that any test result, by any method (eg, RT-PCR, ELISA, monoclonal antibody, etc), from any source (eg, point of care, patient self-testing, etc), is error free and equivalent and comparable.

You, however, can fill the misunderstanding gap by sharing your knowledge and expertise. Reach out and teach non-laboratory professionals about why different tests must be interpreted differently. The patient getting the appropriate diagnosis and treatment may depend on you.

At every opportunity, or by even creating an opportunity, demonstrate your expert knowledge and raise the quality of healthcare. You know what to test, when to test, where to test, and how to test. Talk to friends, family, nurses, et al about true positives, true negatives, false positives, false negatives, and the predictive value of different lab tests so that they will become knowledgeable and more engaged in their own healthcare. Share your knowledge about sources of error in the pre-analytic, analytic, and postanalytic phases of laboratory testing, and how these sources of error create false positive and false negative test results. Most importantly though, do not forget to share your knowledge about how the multiple and complex quality management processes that accredited labs use minimize these sources of error so that accurate test results are reported. Emphasize how nonaccredited labs and point of care testing may not follow quality management processes with the result that lab test results from these sources may not be accurate. Your teaching will create appreciation for your knowledge and skill, and substantiate your profession and you as a professional on the healthcare team.

Commence

“Commence” means to “start or begin.” From now forward is where you start your career as a laboratory professional. Do not forget that what is done to or for a patient is directly related to your work (eg, the lab test results you generate). You have a critical role on the healthcare team. Do not hide behind the “clinical lab curtain.” Come out from behind that “curtain" and be proactive to substantiate your role on the healthcare team. Help create and spread the true image of who and what a clinical laboratory scientist or medical laboratory professional is. I wish you the best of luck and success in your career.

Fred Rodriguez

Past President of ASCP