Readers Respond

May 1, 2011

Letters to the Editor

Readers Respond

Press the button?

I just read your “What I have Learned” editorial (March 2011, page 4). I enjoyed reading it and thought it was very well written. It brought back some not-so-fond memories from my distant past. When I left the Army in 1975 as an Army-trained medical laboratory specialist after serving at a 200-bed hospital in Germany for two years, I thought I was pretty well trained and experienced (especially since we worked 24-hour shifts). I came back to Washington, DC, and was hired by a physicians' group and ran their small lab. CBCs, Glu, liver, and heart enzymes, and UA.

What I am getting to is that in some states and the District of Columbia, the doctor's office must have five or more physicians before they are inspected by the state health department. I had major complaints which I discussed with the physicians regarding: standards, controls, instrumentation, maintenance, and more. Ongoing training — forget it. I could not find a hospital lab fast enough.

Bottom line, in the 1970s and 1980s, at least, the statutes on the books allowed literally hundreds of labs to operate in physician offices without inspection or decent QC — and, of course, the harm of inaccurate patient results. Many times these labs were operated by personnel without lab qualifications: “Just press the button.” If the inspectors checked, they would have been horrified. I wonder what the statutes are today? Thanks so much, and I look forward to reading more articles.

—Michael Scher, BSMT

FRS, Laboratory Operations Manager

Food and Drug Administration

Center for Food Safety and Applied Nutrition College Park, MD

Editor's note: It is always a pleasure to hear from readers who take the time to “converse” via email about today's laboratory and how it is changing. Michael Scher is one of those readers. Thanks!

Well-known voice from MLO's past

I read your most recent editorial in MLO about waived tests. My focus for decades has been to push for improvements in devices that can be used by patients. When you make good instruments, you can get good results from relatively unskilled people. Blood-pressure monitoring is a case in point. High-end automated self-monitoring blood-pressure devices are superior to random checks in a doctor's office. My internist did not believe it until I bought two of the devices and clearly demonstrated in his office that his office readings were sometimes specious and also failed to show what was happening throughout the day. I did not have high blood pressure. In fact, my pressure throughout the day was more often at the very low end of “normal” limits because I exercise regularly and am not overweight. Your focus on quality and accuracy is not misplaced, but good people cannot do a good job unless management supplies them with good tools, proper staffing, and more.

—Ray Gambino, MD

Boca Raton, FL

Editor's note: And to hear from MLO's “founding father,” Ray Gambino is equally a pleasure. Thanks to Dr. Gambino for pointing out the obvious! Good people, skilled people, well-educated people really cannot do a good job unless…. That's truly is something for readers (and me) to ponder!

It may not be “a little dementia”

In the [cover sidebar] article, “Sepsis poses life-threatening response to infection” (November 2010, page 14), I was surprised to see no mention of another clue to the possible presence of sepsis with regard to elderly patients. That clue is confusion. If your elderly patient, otherwise cogent, displays confusion, it is possible that sepsis is underlying it. Often, our first thought regarding confusion is to say that “it is a little dementia,” not realizing that in the elderly population, confusion can equal many things — including sepsis.

—Donna Eliason
Palm Bay, FL

Editor's note: We appreciate Ms. Eliason's information about confusion possibly equating in the elderly to sepsis. In her home state of Florida (and ours), there are significant numbers of elderly. We are making a note of this!

Get out that crystal ball

I really enjoyed your “Predictions” article (January 2011, From the editor, page 4) from various sources concerning the future of the lab, including small labs like mine at a student health center. I would like to see this as a regular feature with the ever-changing healthcare regulations.

Jerome Witowski, MT
Laboratory Supervisor
Student Health Center
Texas State University
San Marcos, TX

Editor's note: Thanks to Mr. Witowski for what is a wonderful suggestion. Look for more predictions as the months roll by! And check out MLO's Current Buzz feature, as well as other “trends” interviews with industry experts on new tests, new equipment, new techniques, and new services!

MLO welcomes letters to the editor. We ask that you include a phone number for verification. While we prefer to publish the writer's name, we will publish a letter with “name withheld by request,” but our editorial staff must have the writer's name confirmed for our fi les. MLO reserves the right to edit any letter for style and length.