The conduit of credibility
Paul A. Raslavicus, MD
To find the best electrician, I do not look in the Yellow Pages. I seek out
a personal referral, if possible. Faulty wiring isn't something I want to discover the hard way.
Success in business is very similar to success in political advocacy.
Both are about establishing a solid reputation, then earning it
again and again, one day at a time. Both are also about persuasion.
A winning argument begins with credibility. The work of pathology
in Washington is about forming personal partnerships with critical
decision-makers, establishing credibility, demonstrating what motivates
us, and showing what we can contribute. If the information we need
to share is analogous to electronic bits and bytes, our reputation
is the conduit that ensures its safe delivery.
We contribute much. Science moves fast: Molecular genetics didn't
exist when CLIA was passed, and now HHS has an advisory committee
to grapple with the implications. Bioterrorism is a threat, but
SNOMED and other sophisticated communication systems are powerful
tools to temper it. There is much to be done to protect the public
Building relationships in Washington is complicated by the high
turnover in Congress. The institutional memory of CLIA, for example,
is limited to the few incumbents in office 13 years ago. We must
educate each new generation of policymakers—and new generations
are only two years apart in the House—about why laboratory
quality is a life-and-death matter for their constituents, how readily
quality can be compromised, and what the community of pathologists
working with the College can do to help policymakers frame good
law and sound regulation.
Everyone in Washington is an advocate, and every advocate has a
motivation. CAP lobbying has always been motivated by pathologists'
commitment to optimal quality in laboratory medicine. We were centered
on laboratory quality long before CLIA; much of CLIA is based on
the voluntary Laboratory Accreditation Program created by pathologists.
When appropriate, we will partner with government. We can protect
the tradition and ethics of medicine and ensure that regulation
is effective and meaningful. Intelligent laws and regulations, thoughtfully
enforced, are our best prevention against loopholes, the short circuits
in a system that is meant to protect patients.
Like my electrician, we build credibility by cultivating relationships.
We seek out legislators and staff with relevant responsibilities.
We testify before congressional committees when bills and regulations
are debated. We nominate members to serve on advisory committees.
We meet with key legislators and staff. In October, for example,
I had lunch with Tommy Thompson, the secretary of the Department
of Health and Human Services. Later that month, Jared Schwartz,
MD, PhD, and Paul Bachner, MD, made a trip to Atlanta to confer
with officials at the Centers for Disease Control and Prevention
about how we can work together against bioterrorism. We partner
with congressional and administration leadership in multiple ways
at multiple times.
The College has unique responsibility as the only organization
that solely represents pathologists and has only physicians as its
members. We collaborate with other laboratory groups, but much of
our effectiveness lies in our ability to maintain our identity as
the only organization exclusively made up of pathologists—the
medical decision-makers in the laboratory. On most issues we find
ourselves in agreement with our clinical laboratory colleagues,
but on issues affecting the practice of pathology, the College must
and does lead rather than follow.
We do compete with the 50 medical organizations in Washington,
not on issues, but for the time and attention of elected officials
and policymakers. Therefore, when we communicate, we need to keep
the static off the line by staying focused on pathology-specific
As advocates for pathology, one of our best tools is a laboratory
tour for a member of Congress hosted by a CAP member. In this relaxed
and interesting setting, the senator or representative can learn
firsthand what pathology is about and why quality is so critical.
Our goal is to host more than half the members of the House of Representatives
on CAP-sponsored laboratory tours during the next five years. Our
members have led 81 lab tours since 1999. The House has 435 members,
so a majority means 218 tours. We're well on our way.
We have abundant evidence that laboratory tours work. Our lobbyists
can provide an impressive list of concrete actions showing that
educated legislators—those who have toured a laboratory—will
support quality laboratory medicine. This is true grassroots political
action, and we need your help.
Most of the pathologists who have hosted tours for members of Congress
are members of the Pathology Advocacy Network, a grassroots program
to connect pathologists with senators and representatives as resources
on matters of public policy. Many network members are graduates
of the CAP advocacy school, offered in the spring (April 7-9, 2003)
In building our advocacy network, we need to make sure that good
facts are communicated. I often turn to "PathNet" and "Statline,"
electronic publications written by the CAP Washington office staff,
to stay up to date. The biweekly newsletter "Statline" appears in
the advocacy section of the CAP Web site. "PathNet," a weekly look
at current bills and regulatory proposals, is sent by e-mail to
CAP members who have joined the Pathology Advocacy Network.
The College also hosts dinners and fundraisers for lawmakers. These
small dinners accommodate easy give-and-take between our representatives
and key lawmakers. Our participation in fundraisers is made possible
by those of you who contribute to PathPAC. Fundraisers are excellent
opportunities to meet and talk with incumbents and new candidates.
I cannot overstate the importance of contributing to PathPAC.
While most of our advocacy work relates directly to pathology,
we work with the AMA on broader issues, such as liability reform
and the Medicare fee schedule. We share common concerns with colleagues
in hospital-based specialties; our collective issues often funnel
through the AMA. To achieve effective leadership roles in the AMA
House, we need your help. If you are an AMA member and have not
yet designated the CAP as your specialty representative to the AMA
House of Delegates, please do so today by visiting www.cap.org.
As your New Year's resolution, please consider getting involved
in CAP advocacy. Each pathologist who opts out creates a small short-circuit
in our message. We need to remember that the fire in every furnace
starts with a single spark. Let's keep the house of pathology warm,
humming with the collective energy of 16,000 credible voices.
At CAPTODAY press time, the Joint Commission on Accreditation
of Healthcare Organizations announced that it was entering into
a collaborative arrangement with the American Society for Clinical
Pathology for laboratory inspection and accreditation.
With the help and direction of its members, the College has set
the standard in laboratory improvement. Our lab-director-oriented,
peer-driven, and educational program has established a partnership
with the medical laboratories of our nation's hospitals. The College
intends to keep this partnership strong and of value to all.
more about the CAP Advocacy Network, advocacy school, and laboratory
tours, visit www.cap.org, click
on "Advocacy," and follow the links, or contact Rebecca Woodcock
at 800-392-9994 ext. 7105; firstname.lastname@example.org.