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We have ourselves to thank for the sad state of our profession.

Over the years I have at various times been upset, frustrated, discouraged, and impatient with my fellow laboratorians. Now I am angry. I feel that too many of us have become apathetic and unwilling to take a stand on issues that are important to us all.

What fired me up this time was reading Walt Bogdanich's controversial book, "The Great White Lie: How America's Hospitals Betray Our Trust and Endanger Our Lives" (Simon & Schuster, 1991). As soon as I finished it, I felt that every ethically minded health care professional should have read it and been inspired to do battle for reform.

The author's credentials include the series of Wall Street Journal articles that blew the lid off Pap mills and other poor laboratory testing practices. These articles, which were instrumental in spurring Congress to pass CLIA '88, won Bogdanich the 1987 Pulitzer Prize for investigative reporting.

In his powerful new book, Bogdanich exposes greed, fraud, and abuse in the health care industry. He cites cases in which patients died as a result of negligent laboratory testing. As I read his discussions of fraudelent laboratory billing and other lab-related issues, I wondered how many MLO readers worked at the institutions mentioned, and if so, what they might have done to prevent at least some of the problems described. Did they notice? Did they fail to speak up? If so, why?

Bogdanich presents chilling episodes of physician incompetence that must have been recognized by other health care workers at the time. I worked in labs long enough to know that physician errors occur. I did nothing about them in those days, either. I was too young and insecure to recognize my own accountability to patients, so I kept quiet. I wouldn't today.

* Rampant indifference. Clinical laboratory professionals tend to be so wrapped up in obtaining credentials and enhancing our professional status, public recognition, and salaries that we have lost sight of our responsibility to the patient. I'm not saying that personal achievements aren't important, but where are our priorities? What is each of us doing to make sure the kinds of criminal acts described in "The Great White Lie" are not perpetuated? While such flagrant abuses are hardly the norm, every case is one too many.

Laboratorians are not alone in having vested interests. Other health care professionals are equally passive and equally to blame. Numerous newspaper and magazine articles have observed a correlation between rising health care costs and the vested interests of various health care providers. It seems that for the most part, providers do not see themselves as part of the problem (or part of the solution). That isn't necessarily true. In rare instances, health care providers have united with their communities to eliminate recurring problems. It can be done.

* Lost opportunity. Recently our profession had a golden opportunity to demonstrate our professionalism and expertise, but we blew it. Before CLIA '88 was finalized, every lab professional should have written to the Health Care Financing Administration (HCFA) suggesting ways to improve the quality of laboratory services and encouraging reasonable personnel standards for physicians' office laboratories.

Of the 60,000 comments sent to HCFA, only 11% came from nonphysician laboratory practitioners--in my opinion, the true professionals in our field. Over 40% of the letters came from attending physicians and a large number from instrument manufacturers. The Government listened to the majority, who stated that physicians are competent to perform or supervise testing in their labs on instruments requiring little or no knowledge and skills. Rather than strengthening the quality of testing, CLIA '88 may weaken it. What a way to repay the members of Congress who supported our cause and passed what they considered to be appropriate remedial legislation.

Perhaps many laboratorians believed that our professional organizations would speak on our behalf. We are at a disadvantage in that no single association represents us all. Individual agencies would rather protect their turf than join forces to present a unified voice.

To the members of organizations that fought for an all-or-nothing position on personnel standards, I say that your unwillingness to compromise with each other and with HCFA will cost us dearly. Sadly, our patients have the most to lose.

We now face a tougher challenge than ever. We will have to mend a lot of fences and do plenty of lobbying to regain our credibility as experts in the technical and quality-related aspects of laboratory testing. Are you willing to give just a bit of your time and energy to save our profession?
COPYRIGHT 1992 Nelson Publishing
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Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Title Annotation:clinical laboratorians
Author:Barros, Annamarie
Publication:Medical Laboratory Observer
Date:Jun 1, 1992
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