Laboratory tests have never been more complex—or numerous—than they are today. As a result, physicians are confronted with a staggering number of options, and are often left to order and interpret tests with which they have little training. In pharmacogenetics, for instance, just 11% of physicians have formal training, and less than half are able to get the information they need from available resources, according to research from the American Medical Association.1
Laboratorians, as experts with the deepest knowledge of testing, are in a unique position to help fill this physician information deficit. By taking a proactive approach to sharing their knowledge, laboratorians can help ensure that tests are selected appropriately, that results are interpreted accurately, and, ultimately, that patients receive better care.
Here, our lab leaders share several ways that laboratorians can start to take action.
"The first step, " says Michael Laposata, MD, PhD, Professor and Chairman of the Pathology Department at the University of Texas at Galveston, is to get out of just throwing numbers over a wall. As lab leaders, we have to produce a paragraph contextualizing test results."
Laboratorians not only understand the usefulness of a diagnostic test, but its limitations — all in the context of the patient. That enables lab leaders to provide insight that physicians wouldn't otherwise have. Alison Woodworth, PHD, Associate Professor of Pathology and Laboratory Medicine at the University of Kentucky, explains that, "We can combine the utility of diagnostic results with things that might cause a result to be incorrect, like drugs, patient medications, or comorbidities, into a patient-specific interpretive report that's really valuable."
Woodworth recommends creating interpretive guidelines to streamline the creation of reports, especially for particularly complicated or often misunderstood testing. For instance, she partnered with a clinician expert and pathologists at the University of Kentucky to create interpreter guidelines for primary hyperaldosteronism tests, improving the accuracy of diagnoses and resolving utilization issues.
Due to the complexity of certain tests, laboratorians may need to take a more active role in supporting physicians in test selection, interpretation, and even patient mediation. This is especially true in areas such as genetic testing.
Jessie Conta, a Genetic cCounselor at Seattle Children's Hospital, explains that providers generally lack training in genetics, making it difficult to stay abreast of the current explosion in testing options. "I often have to call providers to have delicate conversations—not to undermine their expertise, but to steer them in a more specific direction, ensuring that a test is a good fit for the clinical features in a patient and that results are really meaningful."
While laboratorians may not always be able to act in the strict capacity of a counselor, they should confer directly with physicians when they feel that the latter would benefit from added knowledge and guidance.
In many cases, the best way to account for gaps in knowledge is to have multiple experts convene on a single topic. "We have experts in everything, " says Laposata. "We have to figure out ways to connect ourselves as experts so that we can help everyone in primary care understand what lab tests mean."
One idea is to create multidisciplinary teams, often known as Diagnostic Management Teams (DMTs), that enable experts from numerous departments to fill mutual educational gaps and collaborate on patient care. In oncology, for instance, that might look like a pathologist, a radiologist, an oncologist, and a molecular expert from the lab, the latter of which could explain how a cancer's specific mutations could impact treatment.
Thomas Bauer, a Pathologist at the Cleveland Clinic, explains how this kind of close collaboration has long been common in other areas: "We have always had excellent correlation between the radiologist and the pathologist; I know the phone numbers and the beepers of the radiologists who can actually interpret films better than I can, and they're available all the time. Every time there's a frozen section, we know ahead of time — I've already seen the x-rays and I already have a good idea of the likely diagnosis. That communication ahead of time is just absolutely critical."
In many ways, the key to furthering physician education is to realize that the laboratory isn't merely a standalone department—it's a critical repository of expert knowledge. When lab leaders find ways to share that knowledge effectively, physicians, laboratorians, and patients always win.
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