A colleague, upon checking her lab test results after an annual physical, was horrified to discover a flagged eGFR result of 57 ml/min/1.73 m2; even more so after her research indicated this result could mean she had stage 3 chronic kidney disease. She immediately called her primary care physician, who informed her that since her creatinine value hadn’t changed in more than 25 years (it had been 0.9 at 29 years of age and again at 59 years of age), he ignored the eGFR as useless. So what’s the purpose of an eGFR? If physicians are ignoring it, is it necessary and important to report it with every creatinine value?
Chronic kidney disease is an increasingly huge problem facing the American population. According to the the National Kidney Foundation (NKF) Kidney Disease Outcome Quality Initiative (KDOQI) Guidelines more than 4% of the American population suffers from stage 3 chronic kidney disease, with another 3% in stage 2 and 3% in stage 1. It’s well known that renal function decreases with age, and recent estimates suggest that roughly half the US population is over the age of 50. Although creatinine is the most commonly used marker of renal function, it is a remarkably insensitive marker of renal function loss, and new markers are just being discovered and validated. Glomerular Filtration Rate (GFR) is considered the best estimate of kidney function; however it’s not simple to measure. eGFR is an estimated GFR, calculated from the creatinine the age, gender and race of the patient. It is a way of assisting in the early diagnosis of kidney disease. To help make this diagnosis, urine albumin is an important test to use along with eGFR. In addition, both should be abnormal for >3 months in order to make the diagnosis. Early diagnosis can help prevent progression to renal failure.
The equations for calculating eGFR have evolved and improved, from the early 6-parameter formula which came out of the Modification of Diet in Renal Disease (MDRD) study, to the most recent 4-parameter CKD-EPI formula. For adults, the CKD-EPI formula is increasingly being considered the most useful of these formulas. Formulas are also available for children, and online calculators are easy to find.
When a physician describes what they do they will often say, “I practice medicine.” The reason for this is because each patient, even if they are in similar disease states, usually requires a somewhat unique treatment regimen. The same can be said of leadership. We as leaders are constantly refining our leadership styles, and to a degree practicing what we learn and observe. Just like the patients, each employee we lead is slightly different and it is up to us to adjust to them and not vice-versa. I have been a leader for three short years but my leadership style has already gone through many changes and modifications as I learn and interact with my employees.
I have also been confronted with the challenge of the leader versus manager mentality. The natural tendency when an employee is struggling is to jump in and save the day. However, did you really help them? Perhaps the better approach is to discuss the problem with the employee, give them the tools they need, whether it be knowledge or physical items, and then observe the employee working out the problem themselves. This is the tightrope leaders walk, and it can sometimes feel like the most daunting of tasks.
I start this blog with the hopes of putting together the leadership puzzle by first analyzing the pieces and then taking a step back and viewing the big picture. I just finished my 6th year as a laboratory professional and celebrated by re-certifying with ASCP. I gain my experience through being a blood bank supervisor as well as a general supervisor in a mid-sized community hospital that is part of the larger conglomerate Cleveland Clinic. Working here has given me insight into the entire gambit of the lab as well as how we interact with the rest of the medical profession. I will often refer back to issues and how they relate “outside the four walls.” This is especially important to leadership and how we keep our employees engaged.
Just like in any profession, laboratory medicine faces challenges that are universal to any almost any lab, anywhere. Those familiar with laboratory medicine will recognize these challenges: inadequate resources in labs and in medical technology schools; communication difficulties between lab staff, clinicians and others; patient education; and personnel shortages.
Those who practice laboratory medicine in the developing world know these challenges and more. Poor or non-existent electricity supplies mean that automated machines are not an option, temperature regulation of samples is unreliable, and working conditions are excessively hot. Lack of quality roads and transportation options make specimen or patient transport difficult and supplies hard to obtain. Few educational opportunities mean that lab workers do not receive adequate training or opportunities to practice hands-on skills before working in a lab. Current laboratory employees have few resources with which to improve and refine their skills and learn about the latest research and technology.
The Center for Global Health at ASCP has been working to improve medical laboratories in the developing world since 2004. By providing continuing education training to professionals, assisting schools with the revision of their curriculum, and purchasing needed laboratory supplies the Center for Global Health has touched thousands of individuals and labs around the world. You can read more about their work and find additional stories here.
Every month on this blog, I’ll explore the world of laboratory medicine in the developing world. I’ll also discuss topics such as equipment maintenance (how do different climates affect equipment functionality?), development aid (how do non-profits and other forms of aid impact changes in the lab?), and communication with the clinician (how does this work in a non-digital world?), among others. I hope to provide a few interviews of those working on the ground in the developing world and am open to your questions to guide our blog ‘conversation’.
If you’re reading this, you’ve stumbled onto the inaugural post for the Lablogatory–the blog for medical laboratory professionals. It’s dedicated to helping phlebotomists, clinical laboratory scientists, pathology residents, and pathologists perform their jobs better. We’ll have information on new technologies, posts by lab professionals working in the field, and polls to gauge your opinion on various topics. We may also have the occasional comic-relief post.
Actually, this blog is edited by a laboratory professional. Comic relief comes with the territory.
Come in, look around, and see if you like what we’ve done with the place. We’ll post new content often, so be sure to check back. And don’t be shy about using the comments! We hope you enjoy your time at Lablogatory.
–Kelly Swails, MT(ASCP), web editor, Lab Medicine