Fond memories from an expert

March 1, 2009

In my 25-year association with MLO, remarkable
changes have occurred in the laboratory. MLO, at the forefront of
these changes, has frequently been first to discuss new management,
regulatory, and quality issues. One early edition of MLO featured
an in-depth discussion of regional reference labs, a new concept at the
time. Few large automated labs existed; I was director of one. Our
automation consisted of a Technicon 6/60 autoanalyzer, capable of doing
six tests simultaneously at the rate of 60 samples per hour. We
performed testing for several hospitals in our city and across the
state. Samples came by Greyhound bus; we ran tests during the night and
manually teletyped results back to hospitals. Later MLO headlined
articles on how to select and contract with a reference lab, and how to
decide which tests to send.

George Lundberg's 1972 innovative article on panic
values (critical values) first appeared in MLO. The concept of
direct notification to caregivers of lab values that indicate an
immediate threat to the patient has become a vital quality tool and is
now required by CLIA and The Joint Commission (TJC). Over the years
has carried many articles about quality management. As CLIA
became a fact of life in the lab, MLO guided its readers in the
law's implementation. For instance, a series of articles demystified the
calibration-verification process. One article revealed how to get a
perfect score in a lab inspection. MLO has a wide circulation
outside of the lab community, as indicated during our general hospital
inspection, The TJC surveyor, upon our introduction, said to me, “So,
the guy who wrote that article.”

We had articles on how to select the most appropriate
equipment for your lab and how to get good service when you need it. We
examined the roles of personnel in the lab. One early article entitled
“The Flight of the Peregrine Pathologist” explained why pathologists
moved so frequently from job to job. Another article, written by a
pathology assistant, described the role of this professional who
performs autopsies, examines, describes, and prepares gross surgical

My favorite part has been MLO's Tips column,
the first of its kind in a lab journal and consistently the most popular
part of MLO. We attempt to answer each reader's question in a
timely manner and receive many more questions than can be published each
month. Each Tips panel member has an area of expertise (i.e., chemistry,
hematology, or microbiology). When it came time to assign my area, I was
given “all others.” In practice, that turned out to be urine, feces, and
specimen collection. We have published more than 1,500 Tips answers
during the column's 33 years — and I have answered almost 400 of them.
Over the years, the largest number of questions has concerned specimen
collection and handling. We are lucky to have an expert, Dennis Ernst,
to field these questions now.

Some questions are significant issues and are asked

  • How do you draw from an arm with an IV?
  • How do you draw from an IV line?
  • How long after a transfusion can you draw a
  • Why are we getting so many high potassium values?
  • What size needle should you use?
  • How does a small lab (such as a POL) set
    reference intervals?
  • What is the critical value for (name your analyte)?
  • How do you set delta check values?
  • How many techs do you need for a specific

Then there have been some interesting and challenging questions such as:

  • Does chewing gum alter fasting tests?
  • Can you brush your teeth before a fasting test?
  • Can you use jelly beans for a glucose-tolerance
  • Is glucose test drink a medication?

My journey on the MLO editorial advisory board
and with the Tips column has been stimulating and educational, and has
brought me into contact with many lab experts. For 40 years, MLO
has been a leading laboratory journal, free of commercial bias, and peer
reviewed. I look forward to many more years of its publication.