I must compliment Cris Anderson, MD, for his articulate
and excellent letter regarding the MIME testing (July
2005). We received two test sets when we took the exam. The test sets
that we used contained five straightforward slides, two equivocal unsatisfactory
samplings, two borderline low-/high-grade lesions, and one very difficult
case that everyone called negative but according to the graders had a
few small high-grade cells.
Eighty percent of us failed because of one very difficult slide and nine
correct responses. Dr. Anderson is correct in that this untested and unproven
exercise has no relation to the real world. Where is the "ASC-US,
cannot rule out high-grade lesion," which is an accepted diagnosis?
Where is the collegial collaboration on difficult cases that is mandatory
for the best patient care?
I’ve never been prone to paranoia, but is there a hidden agenda? Could
it be that now as the profit has returned to Pap tests and $60 charges
are common, there is a government-corporate agenda to drive the independent
labs out of the Pap testing business?
As a practicing pathologist in central Indiana, I know that the laboratory
associated with MIME misses its share of dysplasias and invasive cancers.
It is an excellent laboratory, but the complexity of reading Pap smears
as yet defies infallibility. This testing program needs to be eliminated.
Gregory H. Ellis, MD
Director of Laboratories
St. Johns Health System
As a pathologist and director of one of the few remaining medical technology
schools, I believe we are ignoring at our own peril the problems related
to medical technology careers. As pathologists, we are endangering ourselves
because medical technologists, as we all know, are of great strategic
significance in the laboratory.
Medical technologists have bench-level experience that helps the laboratory
director evaluate potential technology alternatives. They can and do extend
the breadth of control of one pathologist to very large operations. They’re
a lot like physician assistants, but unlike PAs, medical technologists
are tightly linked to quality control. Thus, I would posit that the future
of the clinical laboratory under pathologist control is inexorably linked
to the future of medical technology as a career.
Despite this link, I see little evidence that pathologists are supporting
measures to increase medical technologist salaries or improve the recognition
of the medical technologist as something more like the physician assistant.
If you accept the premise that we will need medical technologists in
the future, and realize that the cadre of current technologists is nearing
retirement, then you must support licensure requirements for the technologist.
Such requirements will increase professional recognition for technologists,
and they could help address salary issues and in the long term the supply
of MTs. In some states, a nurse with no experience can earn more than
a well-trained technologist with 10 years’ experience.
It sounds odd, I know, to support anything that could lead to higher
salaries in today’s medical environment. But if we ignore the problem
and let the MT career vanish, Wall Street will change the field radically
or technologists will unionize. Neither option serves the interest of
patients or pathologists.
Jeffrey Tarrand, MD
Chief, Microbiology and Virology Laboratories
M.D. Anderson Cancer Center
Communication with clinicians
Karen Titus’ excellent article, "For digoxin, simple fix to stubborn
problem" (July 2005), brings to light a chronic and disturbing issue:
The communication between pathologists and clinicians continues to be
dysfunctional. In the article, Peter Howanitz, MD, recalls many years
ago finding (with his laboratory colleagues) digoxin-timing errors at
the hospital where he was working. Physicians were notified, and many
became hostile. "They told us we were telling them how to practice
medicine," he said.
Why do clinicians, who should consider us medical colleagues and peers,
so disdain clinical pathologists? What have we done to engender such feelings?
Why do they perceive our assistance as their loss of autonomy in treating
their patients? We have no conflict of interest and no notion of competing
for their patient. We simply support them by providing prompt and appropriate
laboratory services, and accurate results, for the benefit of their patients.
Anesthesiologists recently scored a glowing report in the Wall Street
Journal for the actions they have taken in the past several years to improve
care and lower their malpractice insurance costs. We have not heard that
surgeons were up in arms over their colleagues’ actions. Why should improvements
in laboratory medicine be isolated to never-ending incremental steps to
improve already impeccable analytical testing? We are constantly held
responsible for pre- and postanalytical errors beyond our control. Obvious
solutions are often rejected.
P. Ridgway Gilmer Jr., MD