“Laboratorians need to be contributing more than just test results,” argues Michael Laposata, MD, PhD, a professor of pathology at the University of Texas Medical Branch in Galveston. Today at 4:00 pm Central, Laposata delivers the opening plenary of the 2020 AACC Annual Scientific Meeting, in a talk titled “The Path to Indispensability for Laboratory Scientists: Becoming the Most Important Members of the Diagnostic Healthcare Team.”
Since the implementation of clinical assays, laboratorians have played a crucial role by producing accurate test results that are essential for diagnosis and patient management. However, the near logarithmic increase in available diagnostic tests makes it increasingly difficult for physicians to order the appropriate test, correctly interpret the result and use the information to guide patient care decisions.
Laposata explains that the amount of available knowledge about any disease is far too great for any one physician to learn and use clinically, even for specialist physicians working with their area of expertise. As a result, laboratory tests are frequently over- or underutilized, and results are often interpreted incorrectly.
What is the answer to this conundrum in diagnostic testing? Laposata makes the case that the solution is greater collaboration among physicians, laboratorians, and other members of the patient care team: a group he calls the diagnostic management team (DMT). The primary goals of the DMT are to 1) optimize the utilization of laboratory tests, 2) shorten the time to diagnosis, and 3) increase the accuracy of diagnosis.
DMTs can tear down the walls between ordering physicians and laboratorians, allowing those in laboratory medicine to play a primary role in solving the diagnostic puzzle, especially for complex cases. The goal for laboratorians should be to optimizes patient care by providing information that helps rapidly establish the correct diagnosis using only the necessary laboratory tests.
“While medicine has not laid out the red carpet for us, the barbed wire inhibiting our participation is gone” Laposata says. “It’s time for laboratorians to help serve their hospitals and their patients as diagnostic experts.”
In his plenary address, Laposata emphasizes that DMTs function best when they include everyone who can effectively contribute to a faster and more accurate diagnosis, regardless of his or her degree. There is no room for marginalizing content experts in a healthcare system in which diagnostic tests and their interpretation are so poorly understood.
The potential benefits of DMTs are enormous, according to Laposata. He argues that implementation will lead to considerable increases in the number of accurate diagnoses in a much shorter timeframe.
We know that research backs up his prediction. For example, a 2015 report from the National Academy of Medicine estimated that 64,000 deaths occur annually in the US as a result of diagnostic error. Laboratorians’ input will lower this number by ensuring correct test selection and interpretation. In addition, because laboratorians are adept at knowing when a laboratory test is inappropriate for a specific patient, their consultation services are likely to decrease healthcare dollars wasted on unnecessary testing.
The primary take home from Laposata’s talk is that laboratorians must become indispensable to the diagnostic process. “When I came to laboratory medicine as a trainee, I had no idea about the large knowledge gap I would be able to fill on test selection and result interpretation,” Laposata says. “When I realized that the gap was not only large but growing rapidly, I began to think about the creation of the ‘functional unit’ for our consultation activities, which ultimately took on the name of DMT.”
What better way to start the AACC Annual Scientific Meeting than with the pioneer of DMTs urging our community into action? It is our turn to take medicine forward by a quantum leap. Playing this critical role in clinical consultation regarding test use and result interpretation will make laboratorians truly indispensable in the clinical setting.