By Cullen M. Lilley and Kamran M. Mirza.
As you sit in your hospital room after surgery, a feeling of uncertainty may start to grow. Each tube blood draw is like a tally mark for another day gone by without an answer. Meanwhile, each tube of blood, biopsy material, or the resection from your surgery works their way through the laboratory, passing from specialist to specialist, until they ultimately reach another physician, the pathologist. This laboratory team diagnoses your condition, subtypes it, and performs a myriad of tests (including molecular testing) that guides your treatment and predicts your prognosis. This data is ultimately delivered in a thorough pathology report to your treating physician in a timely manner. Every single tissue sample, tube of blood, and swab goes through the laboratory, but unlike the patient-face physician, these physicians, medical laboratory scientists, technicians and technologists are not often seen by you, the patient.
Imagine clinical medicine without laboratory diagnostics. It would be a guessing game. These guesses would be based on age-old physical exam findings with low-to-poor levels of sensitivity and specificity. However, when the physician’s acumen and the right physical exam findings are paired with proper laboratory data and the correct diagnosis, appropriate and targeted treatments can be initiated, and care plans can be drawn. Laboratory tests like the complete blood count, the basic metabolic panel, the thyroid panel, and the lipid panel are central to the diagnosis of the most common diseases plaguing the United States are many Western nations. Such tests are happening in the hundreds to thousands in every laboratory, every day.
The trouble is that the laboratory has been mostly out of sight and out of mind when it comes to addressing issues of healthcare. There has been a declining laboratory workforce over the past few decades, coupled with and a diminished understanding and lack of emphasis on expanding testing capacity when needed. The fractured laboratory has been put under a microscope during the ongoing COVID-19 pandemic which has put some members of this field in the spotlight. This spotlight, however, has proven to be short-lived. Just as the “healthcare heroes” signs start to become a distant memory, so will the world’s understanding of pathology and laboratory medicine.
In response to the transient spotlight placed on this field, many laboratory professionals have taken this moment to advocate for the field and push for changes that would improve the lab’s ability to respond to the ever-more-frequent metabolic and infectious disease pandemics sweep across the globe. However, without a framework of actionable improvements, the field will likely sink back into the background where it had sat for so many years. As a call to action, we decided to analyze the central areas of concern for pathology and laboratory medicine that could be tackled to improve (1) the lab’s ability to respond to the changing demands of medicine and (2) patients’ access to high-quality diagnostic pathological care.
In our paper, we provide a constructive framework with focus on improving clinician test choice, appropriately triage testing, be good stewards of healthcare dollars, continue laboratory improvement programs, promote just advanced diagnostic distribution, and recruit a more robust laboratory workforce. Each one of these domains is explored in detail, but an overarching theme expressed with attempting to address them is improved interface with patient-facing physicians and advocacy for the field.
Though the goal of improving patient access to health care is an immensely multifactorial issue, pathology and laboratory medicine cannot be left out of policy conversations because of their integral and indispensable role in the diagnosis and care of patients.
Author: Cullen M. Lilley and Kamran M. Mirza
Affiliations: Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center
Competing interests: None to disclose