Find Your Passion and Become Engaged

What does it mean to be engaged? Since I’ve been involved in grassroots organizing and health advocacy for most of my adult life, I believe its means to find your passion and become a proactive participant and not just a spectator – for me that has always meant educating those in minority and immigrant communities and those who affect these communities on health equity issues as well as fighting for the rights of those who are marginalized within these communities. I spent much of my time in medical school working as the head of our mobile migrant farm worker clinic, as a Schweitzer Fellow helping to promote free hepatitis B screenings and free vaccinations at two free health clinics, and co-organizing multiple health fairs that served the Philadelphia Asian community. I also worked as the national grassroots leadership coordinator and subsequently, national chair of AMSA’s Race, Ethnicity, Culture in Health (REACH) action committee.

Even though I’m back in Chicago where much of my grassroots experiences began, I’ve had to put these types of efforts on hold. Unfortunately, residency doesn’t always afford enough time for a consistent commitment in terms of my health advocacy. I do have at least enough time to still remain engaged to drive systems change within our profession. If this is something you’re passionate about, what do you need to do first?

Educate yourself on the opportunities out there. Organizations that focus on AP/CP issues like ASCP (the CP here means clinical medicine as opposed to research, not just clinical pathology) and CAP are good places to start. Check out their webpages (www.ascp.org and www.cap.org) to see how residents can become involved. Both organizations have junior positions for residents on their committees and councils and both also have resident councils that you might be able to become a part of. Often, there are also reserved resident positions on committees within specialty organizations (eg – Association of Molecular Pathology aka AMP) as well. Google is your friend. So check their websites often and get on their email lists as most of these position applications or elections (for CAP resident forum aka RF) have deadlines in the early spring. ASCP and CAP also have resident representative and delegate to the RF positions available and each residency program handles the appointment or election of residents to these positions differently so ask your PD.

Many of these committee positions are fairly competitive so you might not succeed at first; simply try again. Build your CV and network at conferences as there are often opportunities built-in for physician leaders of these organizations and residents to meet. You’d be surprised how an innocent encounter with one of these organizational leaders results in an unexpected opportunity. Last weekend, I was in Tampa as the only resident representing our interests with the educational planning committee for the 2014 ASCP Annual Meeting. I had no idea that sitting at lunch with an ASCP leader last spring when I was chosen to be the resident representative at their Future of the Pathology Workforce Roundtable and Leadership Forum would result in her recommending me for this position. I had a great time (and away from the snow and cold in Chicago although I did get stranded in Birmingham for a day on my way back), my opinions were appreciated, and I think the conference is going to be awesome (btw, there is a resident boards mini-course built into this conference every year). But don’t be Machiavellian when you network – just be yourself and you may be surprised at the doors that open for you. If you’re sincerely passionate about something, trust that it will show and that good things will happen.

So, I gave an example of chance encounters that granted me unexpected opportunities and it happened because I was at a conference where I was presenting a poster. So, I highly encourage submitting abstracts and presenting posters at conferences. You never know whom you may meet or how they may touch your life. Plus presenting a poster or platform is a good experience to develop skills you need and to build your CV for subsequent fellowship and job applications. As I mentioned before, residency is not the same as medical school but more like the training ground for your first job. We all must be more pro-active at taking ownership of our education and we must no longer expect that our education will be spoon-fed or organized around our needs specifically. Be aware of and engaged in obtaining what you need because there isn’t necessarily a syllabus for how you should learn during residency.

Becoming engaged and involved with these organizations as a resident gives you a glimpse as to issues that affect our profession, now and in the future. It also gives you an outlet to be a part of that change because our opinions are truly valued – most of the ASCP and CAP committee and council positions support your travel and expenses to these meetings, so they really are making an investment in you and the resident opinion you represent.

And lastly, give your 110%. If you are chosen for a leadership role, take it seriously, work hard, and be humble – being entitled and saying that you were “too busy” if you miss a deadline won’t reflect well on you…after all, we all are busy and that’s where time management skills come into play. So find what you are passionate about and go after it!

 

Chung

Betty Chung, DO, MPH, MA is a second year resident physician at the University of Illinois Hospital and Health Sciences System in Chicago, IL.

Customer Service—The Buck Stops Everywhere!

Laboratories are notoriously hidden in basements, outbuildings, storefronts, and historically have been hard to find, difficult to get to, and in many cases, an afterthought in facility planning. It couldn’t be farther from the truth that “labs should be seen and not heard.” Those of us who live in the lab don’t give it much thought…until we have to get OUR blood drawn, that is!

We all know the scene where someone has a “lab complaint.” It typically centers on having their blood drawn, getting stuck multiple times, having a result not ready, or heaven forbid, having to suffer a “re-draw.” If you think about it, the service we provide that has the customer-facing moment is the specimen collection phase. Our pre-analytical capabilities are where our patients/customers/clients judge the quality and strength of our laboratories. I have often described it to students in this way; if you want to buy a house and its gate is broken, the paint is peeling, the door hinges rusted, and the yard is full of weeds, you automatically assume the house is also “broken down” on the inside. It may have upgraded electricity, brand new appliances and plumbing, and the structure is solid and weather proofed. But you decline to delve further based on the appearance. The second house you see has fresh paint, new hinges on the doors, a little grass and flowers in front, and a nice walkway to the front door with a shiny new mailbox. You are charmed…and, sadly, it has a leak in the main drain, the paint inside is lead-based, the electrical system must be rewired and the structural walls are rotting and soon the stairwell will cave in. Nothing you can really see from the outside, but not something you can judge from the street.

I find that the elements of customer service and the way we present and appeal to our patients/customers is the “face of the laboratory.” Professional presentation and treating each patient and each specimen as if it were your mother’s or your child’s specimen gives our clients the confidence and trust they need to feel good about their test results. Communicating, making eye contact, soothing and reassuring those with “difficult veins” makes any situation go more smoothly. And, since most people are unable to judge the quality of our laboratory work—they have no training or understanding of what goes on in that “black box”—remember the house example. We all tend to judge by our first impressions.

Customer Service is a universal concept, and one that is a challenge in every laboratory, everywhere. One of the most popular international training programs ASCP Global Outreach provides is for pre-analytical phase quality improvement, and it always includes a heavy dose of customer service. Not only with patient engagement, but also with other departments, physicians, hospital staff, and even in community outreach. It is universal all around the world, that customer service makes the difference in how people evaluate the laboratory profession. You may be the best clinical scientist or clinician on the planet and your lab may have won awards for superior performance; but no one will know or care about that if they have a bad pre-analytical experience! The buck really does stop EVERYWHERE!

Next time YOU have to have your blood drawn, take a close look around and notice what your patients and customers see. I guarantee you will always be surprised by something, and will leave the drawing room with at least one idea of how your lab can do it better. Next time, we’ll talk about some ideas I’ve learned about customer service in other countries.  And, if you have a great example of stellar customer service practices, let me know at bsumwalt@pacbell.net I’m always in the market for new ideas to share.

 

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Beverly Sumwalt, MA, DLM, CLS, MT(ASCP) is an ASCP Global Outreach Volunteer Consultant.

 

New Rule Gives Patients More Access

Yesterday the Obama Administration and the Department of Health and Human Services implemented a regulation that amends the Clinical Laboratory Improvement Amendments of 1988 and the Health Insurance Portability and Accountability Act of 1996 in regards to reporting of patient results. Basically, the new regulations state that patients (or their personal representatives) can receive lab results directly from the laboratory. In most cases the laboratory has 30 days to comply with the request. This regulation goes into effect 3/31/14 and laboratories must comply by 9/27/14.

So what does this mean for laboratory professionals? The language of the final rule gives laboratories a lot of flexibility in terms of dealing with a request for information. In a nutshell:

  • Individual laboratories can set up systems to receive, process, and respond to requests for results however they choose to do so.
  • If a state law is different than the federal regulation, laboratories must comply with the “more stringent” law, with “more stringent” meaning “greater rights of access.” For example, the federal regulation requires results to be given within 30 days of the request; if state law requires those results be given with 15 days, then the laboratory should follow the state law.
  • Laboratories need to have “verification of identity” policies in place. There is no mandate that requires specific forms of identification.
  • Laboratories that currently have patient portals in place may continue to use them.
  • Laboratories CANNOT require patients to make requests only through their providers; mechanisms must be in place for a patient to make requests directly to the laboratory. However, laboratories CAN require patients to make these requests directly to the laboratory.
  • Laboratories can recoup the costs of providing results to patients, but the fees must be cost-based and reflect labor, supplies, postage, and preparation of an explanation of PHI. Laboratories CANNOT charge fees that reflect the cost of searching and retrieving information, nor can they charge fees for costs associated with verification, documentation, liability insurance, maintaining systems, etc.  It should be noted that laboratories cannot withhold future lab results if a patient chooses not to pay the fee.
  • Laboratories must provide results in the form (electronic or paper) requested by the individual if readily producible.  This could be a MS Word or Excel document or PDF as well as access to an electronic portal.
  • Laboratories are required to reasonably safeguard information (electronic or paper).
  • Laboratories are not required to include test interpretations but may do so if desired.
  • Providers are encouraged, but not required, to tell patients they have access to their laboratory results directly from the laboratory.

 

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

 

Patient Data as QC

One of the most important things we do as a laboratory is run Quality Control (QC) material on every assay we perform in order to ensure that the assay is working correctly and the test results are valid. The importance of QC cannot be overstated, as it allows us to confidently report analyte values that allow correct diagnostic, treatment and treatment monitoring decisions for each patient for which we provide service. And yet every laboratorian knows that running QC is often problematic.

QC material is not true serum, plasma, urine or CSF and as such, it frequently does not act like a patient sample. This is referred to as commutability – the ability of a synthetic or non-human-based material to act like a human sample in a test system. As hard as manufacturers try to make their QC product commutable, problems still exist.  Every tech knows that a shift in QC is not always reflected by a shift in patient sample results, and conversely a shift in patient sample results may not be mirrored by a shift in QC.

In some cases it may be possible to use patient samples as a kind of Quality Control.  For those tests with high volumes, calculating a running mean of all patient data each month can supply a nice overview of the performance of your assay. For example, if you run 5000 sodiums each month, the average of those 5000 will be consistent from month to month, as long as your analysis system is performing consistently. Very high or very low outliers will be smoothed out by the sheer volume of tests in the data set. Our average monthly sodium has run 140 or 139 mEq/L for the last year. If it were to run 142 or 137 one month, I would look at what happened in the system to shift 5000 sodiums enough to cause that difference.

A test that this system has been useful for is tacrolimus.  At roughly 600 tacrolimus tests per month, our rolling patient mean has been stable for the last 6 months at  7.9 ng/mL, with a range of 7.7 – 8.1 ng/mL. In September, the mean dropped to 6.8 mg/mL. The data was still distributed as it had been previously, with no increased number of values around the lower end, suggesting that the shift was systemic. A look back discovered a new calibrator and calibration. None of this had been reflected by a shift in the regular QC.

Use of patient data as QC will not work with low volume tests, or with tests having a wide reportable range, because a low number of outliers will affect the mean too much. For instance, diabetics in crisis with massively elevated glucose can skew a glucose average even if you run a couple thousand per month. Also this method takes a long-term view of the system. It will not pick up an assay failure on a given day. Despite those things, it can be very useful for looking at systemic issues that affect patient data rather than QC data.

 

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-Patti Jones PhD, DABCC, FACB, is the Clinical Director of the Chemistry and Metabolic Disease Laboratories at Children’s Medical Center in Dallas, TX and a Professor of Pathology at University of Texas Southwestern Medical Center in Dallas.

 

Chutes and Ladders

Mobility in any career can lead you in multiple directions and usually it is up to you which way you go. The laboratory field has become very specialized in the last twenty years and staying a true generalist or a general supervisor is becoming more difficult. I always tell students to stay generalists as long as possible so that your options are open once you get a sound technical foundation of knowledge. This allows them to become supervisors in a number of different areas when the time comes. Much discussion has been made about the proverbial “career ladder” and whether or not the ladder exists as it used to. As an early careerist I am well versed in navigating the ladder and figuring where I fit, and how I plan to climb the rungs as I enter my second decade of my career. I finished my MBA at the beginning of 2013 and put myself into application mode to see what new positions awaited me.

I learned a few things in my quest to climb as many rungs as I could on the ladder. First, if an application states you need a certain amount of experience but you are one or two years short, apply anyway. Employers will at least speak with you if you are a little short. If you wow them with your experience so far in your career and let them know that you don’t just work but you actively observe you can make up that deficit. Second, do not be afraid of lateral moves. If your goal is to be a laboratory director or higher, moving to supervise a different area of the lab can make you a better-rounded candidate once it comes time to go for that higher position. This is especially important if you have become burned out or in need of a change from your current department. Nothing says you have to stay a Hematology supervisor for eight years before you have the supervisory experience to become a laboratory manager/director. One aspect of the lab I find is a good move is to the point-of-care side of the lab. You get out of the lab more and into the hospital as a whole. Usually this role takes on the Quality side of things as well. This role can be a great transition from a technical supervisor to a more general department supervisor where you can learn and grow.

Finally, never be afraid of putting in an application. I find a lot of people talk themselves out of a position before they even apply. Do not be afraid of rejection. In speaking with laboratory professionals, I have heard of a hospital not hiring a candidate for a position but going back and contacting them at a later date for a different position. It never hurts to interview and get your name and face out there. Go on interviews even if you don’t feel the position is a good fit. Practice is the name of the game. When your time comes climb the ladders and avoid those chutes!

Herasuta

Matthew Herasuta, MBA, MLS(ASCP)CM is a medical laboratory scientist who works as a generalist and serves as the Blood Bank and General Supervisor for the regional Euclid Hospital in Cleveland, OH.

Medical Essay Contest

This came across the desks of Lab Medicine’s editors today and we’d like to pass it on. The folks at Hektoen International are running an essay contest.

We invite you to submit an essay of 1,500 to 2,000 words on a subject related to medicine and culture by March 1, 2014. Suggested topics include medicine and art or literature, history of medicine, ethics, music, philosophy, anthropology, linguistics, etc. Clinical studies or case reports are not eligible.

We will be offering two prizes:

  • The Hektoen Grand Prix, for the winner – $1,500
  • The Hektoen Silver Prize, for the runner-up – $1,000

If you’d like more information, please check out the essay contest page.

 

The Poisoner’s Handbook by Deborah Blum–Book Review

I recently read The Poisoner’s Handbook by Deborah Blum, a book about poison and forensic investigation in Jazz-age New York City. Dr. Norris and Dr. Gettler transformed death investigation from a good-old-boy coroner system to one based on science and data analysis. Blum weaves several cases into a narrative that covers several poisons used during the 1920s and ‘30s. Over time, poisoning deaths decreased due to public awareness as well as the realization that murderers were increasingly likely to get caught. Blum discusses Prohibition at length and its contribution to poisoning deaths in New York City. I found this particularly fascinating; not only were people willing to risk their lives to drink alcohol, the government tried to dissuade people from drinking by actively poisoning the supply.

Several of the reviews of this book note Blum’s lack of chemistry knowledge, and I can’t disagree. While my own knowledge base isn’t wide, even I notice a few inaccuracies (HCN isn’t a “potent” acid, for example). One must remember that Blum is a journalist, not a chemist; I tend place blame on the publisher’s fact-checker as well as the author. Because this book is about the evolution of the public perception of forensic toxicology and not just the science behind it, I could overlook the scientific stumbles.

As a laboratory professional, I loved reading about the early days of forensic science and forensic toxicology. While these professions existed in Europe well before 1920, Norris and Gettler forever changed how we treat death, murder, and justice in this country.

 

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.