A recent article in Critical Values by Dr. H. Cliff Sullivan (Claiming Our Seat at the Cool Kid’s Table: A Rallying Call to Pathologists) discussed how pathologists can be a part of the clinical care team but it is a hard job to complete when we are isolated to our offices or laboratories. One of the recommendations by Dr. Sullivan was to engage fellow clinicians in whatever way we can as pathologists. For this blog post I want to talk about one task in particular that has allowed me to be involved with clinicians: clinical Rounding.
When I first started my job, the most senior pathologist and critical care chair asked that I round in the intensive care unit once a week with the clinical team, consisting of nurses, mid-level providers, residents, pharmacists, and attendings . I am sure my face conveyed my baffled thoughts: what could I offer by rounding in the ICU and more importantly, how will I have time for that? However, being a new pathologist, who was I to say no to my boss and the ICU chair? I might be bold on occasion, but not that bold. The first day I arrived for rounds (still wondering what I would be doing, hoping they would not ask a question I did not know the answer to) a question came up about a susceptibility report: the mid-level provider did not understand how an isolate could be resistant to piperacillin but susceptible to piperacillin/tazobactam. It was a perfect way to impart pathology knowledge to the clinical team. As I continued to round on a weekly basis, question after question would come up – what does it mean if an HSV PCR is negative in a cerebrospinal fluid; why are peripheral smears not reported out at certain times; what does this new LIS Sunquest do differently and why is it so slow; what do you think about an alpha-fetoprotein level of 27; what is the mechanism of ADEM? These questions were sometimes very easy to answer and at other times I needed to do more investigation. In addition to answering questions on rounds, these times spent in the ICU have built up relationships; it puts a face on the name of the laboratory and has allowed the team members to reach out to me on different occasions even when I am not “rounding.”
Over the past year I have found that this one undertaking that I was so uncertain of how I could contribute to has now been one of the constant reminders of why I chose clinical pathology as a profession. While these clinical team members might not understand what I do on a daily basis, they all have one goal in mind: providing the best patient care. I like the role of being a consultant and being able to contribute to medical discussions and I have always known that laboratory results can define patient care but attending these rounds has given me first-hand experiences of how the laboratory truly affects patient care. It has been apparent through these interactions how important it is to have someone involved on the patient care team that understands the laboratory and can shed light about why the assay the provider wants to run may or may not be appropriate or why interpreting specific test results based off other confounding factors is so vital. While being a clinical pathologist may be lonely in the fact few people perform my exact job, however being involved with the clinical care team absolves that loneliness and has reminded me that each role has their place in medicine.
Now to hear from you – how do you interact with clinicians outside of the lab? Have you found a way to round with other interdisciplinary teams and if so, what has been the best approach?
Thanks for reading!
-Lori Racsa, DO, is the director of microbiology, immunology, and chemistry at Unity Point Health Methodist, and a Clinical Assistant Professor at the University Of Illinois College Of Medicine at Peoria. While microbiology is her passion, has a keen interest in getting the laboratory involved as a key component of an interdisciplinary patient care team.