One of the recent suggestions for topics in this forum has been “how to interact with clinicians and administrators.” There is a general feeling by some trainees that this is an area in which they wished they had more exposure prior to entering into their first professional position following their training/fellowship.
Thankfully I feel that I had ample opportunity to interact to a significant degree with our clinical colleagues during my training. The experience gained in my training has thus far proved invaluable in my first professional position. I know that we will all have varying experience in these tasks as we progress from training to our first position and for me the bigger challenge was learning how to interact with my administrative colleagues. Since I have had more experience with interacting with clinicians on a day-to-day basis I thought that I would share some of my thoughts on the professional interactions between clinical laboratorians and clinicians.
There are two basic scenarios that frame most of the interactions between clinical laboratorians and clinicians. The first is fielding inbound questions from the clinicians via and email or phone call. The second is reaching out to contact the clinician regarding a test request or test result.
In the first scenario the clinician is likely coming to you with a question regarding a test result, interpretation or possibly a question on the best test or combination of tests to establish or rule out a diagnosis. I consider this an easier task as the clinician is reaching out to you because they have a question regarding a result interpretation or diagnostic strategy. I’ve found that at times I do not have an immediate answer for the clinician, but that is not a major obstacle and with increasing experience in the field I suspect that the accumulation of experience will result in a decrease in these events. In those moments when I don’t have an immediate answer I always attempt to get as much information as possible about the question, patient and other pertinent information that the clinician is able to share with me. This allows me to look into the situation and research the test or result in conjunction with the patient’s clinical picture so that I can report back to the clinician with a helpful answer. It is always preferable to report back accurate information following a delay than to blurt out a supposition or inaccurate information that would need to be retracted later. Remember that you are not dealing with hypotheticals but real patients and accurate information is necessary to establish a diagnosis or monitor a condition.
Recently I’ve found that one of the most misunderstood areas of laboratory testing has been in the interpretation of drugs of abuse testing interpretation, especially in regards to the interpretation of opiate results. If like me you find one area that is commonly misunderstood or poorly understood I find it to be helpful to make a short reference sheet to consult so that I can rapidly review the results and offer immediate and accurate feedback to the clinician. If the reference sheet includes helpful tables and figures with a cited reference I’ve even emailed the document to some clinicians to help them with the interpretations, reminding the clinician that they are always free to contact me if they still have questions. If you have an online laboratory handbook you could even upload the relevant figures or tables there for wider use.
Reaching out from the laboratory to the clinician can at times be a little more challenging. If you are reporting a critical result or altering the clinician to an incidental finding your information will likely be very welcomed. However, if you are contacting the clinician to report that for various reasons that the test they’ve requested is not able to be performed or to discuss the utility of reference laboratory testing you may encounter some friction. Again in this situation it is best to be prepared with as much information as possible before you contact the clinician. If there is a sample quality issue (hemolysis, icterus, wrong tube type, etc.) your hands are effectively tied. It may be possible at times to have the patient redrawn if the issue is a serum or plasma sample with hemolysis but there are times in which the sample, be it a body fluid or CSF, is effectively irreplaceable. In this scenario you have to be honest and explain that because of the quality issue it is not possible to generate the necessary result.
One of the many other duties or tasks I perform is the daily review of reference laboratory testing. This is an area that some of you may already have experience with in your training, and you would probably agree that this can be a challenge. The goal of reference laboratory test utilization review is ultimately to ensure that the right test or tests are performed for the patient at the right time, every time. Part of this process is to ensure that the patient does not get unnecessary testing. There are certain tests that I review that will require a conversation with the ordering provider. This conversation may be frustrating to the clinician as they are under significant pressure to see their patients in a timely manner on their clinic days. The last thing you want to do is appear to be questioning their clinical acumen or judgment. If you do need to speak to the clinician in regards to a test that they’ve ordered it is wise to first review the patient chart and if at all possible the clinician’s own notes regarding that patient. It may become evident upon chart review why the test was ordered, and thus you can avoid the conversation. However should you need to speak directly to the ordering clinician becoming familiar with the patient’s history and the test requested you can have an intelligent conversation about the utility of the test given the patient’s clinical history.
If for instance the provider has ordered a large multigene panel (over-bundling of tests) that includes both autosomal dominant and autosomal recessive genes and there is a clear autosomal dominant pattern of inheritance you can easily suggest to the provider that pursuing the autosomal dominant genes first could save the patient a considerable expense the conversation may go better than expected. The provider may not be aware that the autosomal dominant genes are available separately. Alternatively if they’ve ordered a test that has been surpassed by a more sensitive and/or specific testing strategy explain to them the benefits of the newer strategy and offer to send them the literature to support this assertion. And most important of all, follow-up on what you say you’ll do!
As you progress in your career there is no doubt that your comfort level in speaking to clinicians will increase and you will learn strategies that will work for you. Above all else being prepared with the necessary knowledge is paramount if you are calling the clinician. And recall that if you do not have an immediate and correct answer it is always preferable to research the question and come back with a correct answer or strategy.