The Role of Doctors in the Laboratory

1. The Role of Doctors in the Laboratory Dr. K. S. Adedapo

2. Preambles • By “Doctors” we could mean a Post NYSC doctor who has undergone specialist training in Laboratory Medicine for a minimum of 4 years and has passed the requisite examinations to be addressed as a Laboratory Physician • Such a doctor has a huge role to play in the laboratory process • non Laboratory Physician either with or without PG training

3. Historical lane Doctors have always been the custodian of the medical laboratory • Fathers of Medicine, especially Hippocrates who opined “ that no organ of human body provides so much information by its excretion as does the urinary system” • Urine tasting had been used by the Greek, Chinese, Egyptian, Indians etc since 250BC • Documentation stared in 1425 AD • Beyond tasting a “doctor” must have a keen sense of observation

4. Laboratory/The Role The laboratory is a place designated for systematic examination of specimen, tissue, body fluid etc with science based inferences that impact on health and well being The Role of “Doctors” however .. • Depends on the settings • Private Setting • Secondary Health care • Tertiary health care

5. Scenarios • Private Settings The Doctor(s) in charge usually orders and interpret lab. results whether from in-house lab or elsewhere. • A good knowledge of Medicine and experience is all that is required. • High and low parameters are usually flagged

6. Secondary Setting • Nowadays Pathologists are being employed especially in the fields of • Histopathology, • Haematology, • Microbiology and to a lesser degree • Chemical Pathology. • The role is just slightly different from what obtains in a tertiary centre.

7. Tertiary Setting • The Pathologist is first and foremost a doctor/ Lab. Physician who…. • Understands the pathologic basis of disease, consequently… • Referrals in form of consults and/or samples requests are received in his discipline, including post mortem for opinion on provisional diagnosis, way forward in disease management or the cause of death • ………The patient’s advocate

8. As a Result………… • The first duty line of duty both in secondary and tertiary settings will be to add value to interpretation of sign and symptoms by consulting Physician or Surgeon. • Presents an informed opinion on • samples or specimens –tissues/blood/fluid upon review / analysis • Gives evidenced based opinion on the way forward which will influence clinical outcomes.

9. Scenarios • 1. A woman had a low protein S result and her Obstetrician didn’t know protein S goes down in pregnancy • He advised her to terminate the pregnancy as she could die of blood clot and she did • 2.A patient had a factor VII deficiency and his PT was consistently prolonged. • The Neurosurgeon asked for the patient to be given FFP and then performed the surgery

10. Scenarios cont’d • The patient was Ok. for the first day • The FFP was however given in insufficient quantity on the next day • Consequently the patient bled on both sides of his hemispheres and now can hardly talk or walk • These cases emphasize that Pathologists are needed on what to do with the result of tests • What the implications of the deranged values are and • What steps should be taken for the best outcome

11. Other Responsibilities • Supervision of laboratory processes towards ensuring quality assurance and laboratory accreditation with International accreditation • Ensures quality control in the analytical process through up to date report on the goings on in the lab through the laboratory Manager • The Lab. Manager ensures SOP are followed and • Errors (Pre analytical, analytical and post analytical are reduced to the barest minimum • When noticed , they are addressed

12. AS A LABORATORY DIRECTOR Selects the right staff, especially the Laboratory Manager Delegates much of the day-to-day laboratory management to the Laboratory Manager Concentrates on medical/scientific issues Interacts with medical staff Keeps abreast of relevant literature

13. ENSURES EMPLOYEE ORIENTATED MANAGEMENT • Hire an appropriate number of staff • Trains employees appropriately for their job • Encourage upward mobility • Vary employee's work activities • Provides relevant continuing education • Provides a cheerful work environment • Make sure that more than one employee can perform any given task

14. DELIVERY OF AN EXCELLENT LABORATORY • Responsive helpful customer service • Availability of appropriate tests • Report format easily understood • High quality results delivered in a timely manner • Evaluation and management of test utilization • Involvement in hospital quality improvement activities • Ensures few corrected results

15. Lab Physician/ Clinician Relationship • On going discussion on needed Tests /New test menu • Suitability of such tests, pre analytical variables required • Resolving issues with unsatisfactory results • Keeps abreast of recent advances in biomarkers and equipment • Research Collaboration

16. As a Training Consultant • Trains and prepares Resident doctors towards proficiency in the respective fields • Assesses and prepares the Residents for College Examinations • Training is better achieved by mentoring

17. Conclusion • The Role of doctors in the laboratory is that of the Patient’s Advocate. • As Pathologists several responsibilities are to be undertaken as head of the team even in a hostile environment • Doctors must demonstrate competence and currency to be constantly relevant • We are partners in the business of defeating a common enemy -DISEASE

18. THANK YOU