Clinical medicine is increasingly complex, with a constant evolution in laboratory tests, diagnostic algorithms and consensus guidelines. Practicing clinicians are challenged to keep current with the rapid advances in laboratory medicine, even in the area of their expertise. The 2015 Institute of Medicine report, “Improving Diagnosis in Healthcare,” strongly suggests that pathologist input and interaction with clinical colleagues would improve laboratory utilization and clinical outcome, as diagnosis is truly a team effort.1,2
Educating and providing consultation is a role that pathologists must embrace,2 and is particularly needed in genomics and personalized medicine, both rapidly evolving areas in which many clinicians have not fully trained. Molecular tests are often expensive, and may guide the use of expensive treatments, so “getting it right” is key for optimal patient management. Correct ordering and interpretation of lab tests can affect the speed, outcome and cost of clinical management for many patients.
Thus, pathologists need to stand ready to increase their assistance to clinical colleagues in the correct use and understanding of the results of molecular and other tests. Opportunities exist via individual consultation, by participating in review of send-out or expensive tests, seeking representation on hospital committees that approve testing algorithms and build order sets, or in more routine settings such as case reviews and tumor board discussions. Our training programs must prepare our trainees to assume these roles, particularly in molecular pathology due to the complexity and expense of the testing.
We must also seek ways to make ourselves available to our clinical colleagues more easily. A recent study noted that only 6 percent of primary care physicians consulted with laboratory professions in a given week.3 In this era of expanding, decentralized health systems and extensive use of the electronic health record, it may be more difficult for physicians to access pathology and laboratory medicine staff for consultation and advice.
The patterns of inter-physician communication have also changed dramatically, prompted by electronic messaging texting and so forth. To facilitate timely communication with the lab, we built and implemented an electronic consultation system within our hospital network that allows caregivers to reach the lab with any question via an electronic in-basket message within our EMR system.4 Queries are triaged and answered by in-basket or phone by laboratory staff, residents or fellows. At our institution, approximately 5 percent of these inquiries dealt with molecular questions, often to clarify appropriate test ordering.
References:
- Balogh EP, Miller BT, Ball JR, et al. Improving Diagnosis in Health Care.; 2015. doi:10.17226/21794.
- Laposata M, Cohen MB. It’s our turn: Implications for pathology from the Institute of Medicine’s report on diagnostic error. Arch Pathol Lab Med. 2016;140(6):505-507. doi:10.5858/arpa.2015-0499-ED.
- Hickner J, Thompson PJ, Wilkinson T, et al. Primary care physicians’ challenges in ordering clinical laboratory tests and interpreting results. J Am Board Fam Med. 2014;27(2):268-274. doi:10.3122/jabfm.2014.02.130104.
- Theparee T, Shanes E, et al. A new era in pathology consultation: the MyPathologist electronic consultation tool, Academic Pathology, 2018. journals.sagepub.com/doi/full/10.1177/2374289518798820.
