So … Why can’t an MLS do this?

 

This is a question that I get asked fairly often: Why can’t an MLS do this?

If the questions that were being asked were fairly straightforward, then the answer would be that an MLS could.  But the questions are not that straight forward.

So what questions should any MLS be able to answer?

• What tube do I draw for “X” test?
• How long does it take to get a result for “X” test?
• What blood types are compatible with type B?
• What antibiotics are usually used for Group B Strep?
• What’s the therapeutic range for Coumadin?
• Why was Mrs. Smith’s specimen rejected?
• Why did the lab request a recollect on Mr. Jones?
• What causes specimen hemolysis?
• What tests are affected by specimen hemolysis?
• Why do you think Mrs. Smith’s and Mr. Jones’ blood was switched and mislabeled?

Any MLS should be able to answer the above questions by their own knowledge base.

So what type of questions have I been asked to consult on that would require additional education and training?

• What test should I order if I’m suspicious of carcinoid?
• How do I use NT-proBNP values to adjust my CHF patient’s ARB?
• My patient with known HTN had a systolic pressure increase of 50 during transfusion of their 3rd PRBC. Is this a transfusion reaction or just the HTN?
• What flow cytometry should I order if I am suspicious of APL?
• I have these pharmocogenomic results but I do not know what to do with them. What should I prescribe my patient?
• My patient’s C9orf72 test was inconclusive.  What does that mean and what testing should I do next?

Now I am sure that there will are some MLS that may be able to answer the question that is in their specialty.  And I am also sure that given sufficient time to research the answer, most would be able to find the answers to the questions above.  What a DCLS will need to do, however, is be able to answer these questions while rounding with the physicians.  It will also be up to the DCLS to stay current with the latest clinical guidelines and current evidence-based practices as it pertains to laboratory diagnostics.  There may occasionally be a question that is asked of us that we will have to go do some research on, but we must have the knowledge to answer most of the questions readily.

So what courses have I taken as part of the master’s and doctorate programs in preparation to answer these questions?

Advanced Topics in Clinical Chemistry, Advanced Topics in Hematology, Advanced Topics in Hemostasis, Advanced Immunohematology, Transfusion Practice, Advanced Clinical Immunology, Advanced Topics in Clinical Microbiology, Molecular Diagnostics, Advanced Molecular Diagnostics, Clinical Laboratory Data Analysis, Infectious Disease, Research Methods for the Health Sciences, Evidence-Based Literature Review, Healthcare Regulations & Laboratory Management, Data Analysis and Interpretation, Overview of Disease Processes & Treatment, Pharmacology, Epidemiology, Clinical Laboratory Utilization in Quality Healthcare, Clinical Laboratory Diagnosis & Correlation

This is all to make sure that I, and those that follow me, are prepared for what will be demanded of us in our advanced clinical practice.  That we will be there to improve patient safety and quality of healthcare that our patients receive.  That we will be there to improve the patient safety and quality of healthcare that our patients deserve.

 

Addendum: I wanted to add, after getting some good feedback, that I am not trying in any way to minimize the skill set of the MLS.  MLS professionals are highly skilled scientists and they can answer some basic consulting type questions as I have listed in my post including some reflex testing and appropriateness of basic testing.  My goal in this post was to identify the reason why additional education and training would be necessary to fully take on this role.

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