I just experienced one of those moments when, while searching everywhere else for information, I found the best answer in my own backyard. While gathering information on bird flu, it hit me that there was excellent information right in my domain on CLP’s Web site in our Expert Insight forum (www.clpmag.com). If you haven’t stopped by yet, you really need to take a look at it now—that is, after you’ve read this issue of the magazine. It is an excellent opportunity for you to get answers to those difficult questions you face every day in the lab. Topics addressed in Expert Insight have included the lab’s role in a bird flu pandemic, the mumps scare in the Midwest, the preparation needed to take various exams, and licensure/certification issues. I’ve learned a great deal from readers’ questions and our experts’ answers.

Our newest expert, Brian Jackson, MD, MS, of ARUP Laboratories, offers insight into lab test ordering practices and the problems caused by administering unnecessary tests. He points out that laboratorians are in the best position to monitor inappropriate test ordering, and suggests that they participate in utilization committees that set these policies. In this way, instead of being forced to deal with inappropriate test orders on an ad-hoc basis, the technologist will be backed by a group with the authority to support the lab and its rules regarding when particular tests may be ordered.

Jackson recommends that laboratories commit to a detailed annual review of their complete test-ordering volumes with attention to both cost and clinical impact. Other solutions to the problem of inappropriate test ordering have included requiring ongoing education for clinicians, instituting warning systems that alert clinicians when excessive use of a lab test is suspected, and developing special approval processes that must be followed before certain tests can be administered.

Many of us, including physicians, assume that lab tests are inherently beneficial to patients and that there is little or no potential for harm in administering them. And if the wrong test is ordered initially, the physician can order the correct test later. No harm, no foul. Further, we feel that since there’s no risk in obtaining the test results, the small possibility of discovering an illness is well worth the cost to the patient and the health care system. However, Jackson reminds us that physicians base patient-care decisions on laboratory data, and that every lab test occasionally gives a false-positive or false-negative result. He also refers to the “Ulysses Syndrome,” whereby patients are led through an odyssey of unnecessary tests. More laboratory testing is not necessarily better laboratory testing, Jackson says.

Finally, some of you wrote to tell me that you enjoyed my column last month on humor in the workplace. One reader recalled taking a class years ago with a professor at Duke University, who, while laying out the ground rules for a month-long medical mycology workshop, said, “Rule number 1: Have fun. Rule number 2: Learn all you can about medical mycology.” He suggested that we publish stories from readers regarding humorous situations encountered in the lab. I would love to do this, but it’s up to you to send me your stories.

So, please consider these two CLP action items for the month:

1) Visit Expert Insight at www.clpmag.com, and ask away!

2) Send me your humorous stories, and let’s share a laugh.