The Ignorance of Laboratory Medicine

I was recently at a meeting where a pathologist said, “We have to continually re-educate our clinical colleagues about what it is that we do in laboratory medicine.” At that same meeting, a different pathologist shared his frustration that clinicians were making decisions about their electronic medical records without input from laboratory medicine.

Why do clinicians seem to have a persistent lack of knowledge about when and how to collaborate with laboratory medicine?

Certainly, these are frustrating situations, but more importantly, they may limit our ability to support the mission of our hospital. I would like to reflect on this "ignorance" of laboratory medicine. As a word, ignorance carries a certain weight. I’m not suggesting a malignant motive by clinicians, but rather, observing a lack of knowledge that seems to permeate throughout medicine.

Considering that physicians rarely see a pathologist in everyday clinical life, I can appreciate how easily the illusion of knowledge may be established. Out of sight, out of mind. The other week I finished the book, The Knowledge Illusion. In it, Steven Sloman and Philip Fernbach describe how little we actually know, relative to what we think we know. They do a particularly nice job of explaining both the negative and positive aspects of this reality.

One of their takeaway points is, “The problem is not ignorance per se. It’s the trouble we get into by not recognizing it.”

This resonated with me, as it is relevant to our challenge in laboratory medicine.

Given that we are constantly re-educating colleagues, more knowledge doesn’t seem to be fixing our problem. Slomen and Fernbach would suggest that the opportunity here is to re-structure our environment to enable good decisions based on community knowledge. In other words, laboratory medicine will always be a “blind spot” for clinicians, so ensure that laboratory medicine specialists are represented in hospital leadership decisions. This way, we may avoid ignorance from taking us, our hospitals, and patients on a less-than-ideal course.

Dr. William J. Mayo once said, “The internist, the surgeon, and the specialist must join with the physiologists, the pathologists, and the laboratory workers to form the clinical group.”

Dr. W. J. Mayo was wise to understand that it is not about knowing more than everyone else. The key is to effectively manage what we don’t know by collaborating with those who do. What are our "blind spots"? How can we become more aware of the knowledge that lives in our larger community? Please take a minute to ponder these questions, and then comment below.

KreuterMD

Justin Kreuter, M.D.

Justin Kreuter, M.D., is a clinical pathologist at Mayo Clinic in Rochester, Minnesota. His practice consists of both general and subspecialty aspects of clinical pathology. At Federal Medical Center-Rochester, Dr. Kreuter runs the general laboratory that supports a local in-patient population and does a large amount of reference work. At Mayo Clinic, Dr. Kreuter's time is split between the transfusion medicine service and transplant laboratory. In addition to clinical activities, his academic interests include several aspects of medical education, including teaching clinical judgement, frameworks for feedback, and reflection in medical practice.

Responses

Where can I buy the book? I totally agree with the author and we have tried to establish a relationship between doctors and our laboratory, without much success.
Dr. Guadalupe Gonzalez
Laboratorio Clínico y de Genética SC
Mexico City

Thanks for your feedback Dr. Guadalupe Gonzalez! This book was just recently published on March 14th 2017, so should be available / able to be ordered at your favorite bookstore. After you read it, I’d be curious to know if you have similar or different thoughts regarding this ignorance problem.

Well said!
I totally agree the fact that out of sight and out of mind and what Dr. Mayo said.
The more you are working or living in a place, the less ability to recognize the problem. This is not an ignorance per se, it is the internal intelligence within our mind, our knowledge and voluntarily became what we just know.

Registered Medical Laboratory Technologist, Wendy Nip from Toronto City

Agree wholeheartedly! In an similar vein, I certainly have blind spots in several clinical areas that I have to seek colleagues help to fill!

This is an excellent article, Dr. Kreuter, and I would welcome more like it. Medicine appears to be in a bit of an identity crisis, no? But, we have an opportunity to take the reins to help steer our clinical and surgical colleagues back into more fruitful relationships with ourselves and each other — partly due to the broad areas we serve and the knowledge of disease we have — by initiating discussions and reaching out as the consultants that we are.

When the finest diagnostic medical center in the world makes pathology and laboratory medicine the core of its integrated clinical practice (Mayo), and the US News & World Report doesn’t even recognize this discipline in its annual hospital ratings, you know the rest of the world is blind to the issue. It’s a real shame.

JCL, MD – Toronto

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