TO MY FELLOW PHYSICIAN COLLEAGUES:

I recognize the difficulty that many of you as office-based physicians are faced with in respect to "how do you determine if the laboratory test or diagnosis is correct or not?"  In fact you want to know this because your treatment and management decisions are often based on medical laboratory testing and/or diagnosis, and your patient could potentially have serious consequences because of such.

This question has plagued laboratory medicine practice for some time now, and has of late been the topic of many discussions among clinicians and laboratory medicine professionals.  While regulatory organizations such as CLIA, Joint Commission and others,  have made an attempt at establishing guidelines for detecting, correcting, and reporting of medical laboratory errors,  often times these guidelines are not easily enforceable and are essentially dependent on the level of commitment of the individual medical laboratory to self-monitor quality, accuracy and timely of reporting of laboratory results.

As you can imagine with over tens of millions of medical laboratory testing done on an annual basis in the USA, it is difficult to detect every lab error, and so unfortunately there will be errors that could potentially affect your patients and your clinical practice. In fact, most regulatory bodies require that a laboratory only monitors a certain percentage of ALL TEST RESULTS.  For example, in cytology, only a random rescreening of 10% pap smears is done,which means that 90% of "reportedly normal pap smears" do not undergo rescreening.

Another example of this is in the pathology practice, where for the most part the individual pathologist is required to seek second opinion on difficult cases or ones with diagnostic dilemmas  at his or her own discretion.  Some medical laboratory practices have established guidelines for having more than one pathologist secondly review pathology slides in certain diagnostic specialties of pathology, and this seems to be making a difference in anatomic pathology.  However, with a solo practicing pathologist or a small group of pathologists or in certain circumstances academic based practices, that ability for second reviewing by an independent pathologist is not readily available, and patient may be victimized because of lab error by the academic-based pathologists', small group of pathologists' or loner pathologist's diagnostic reporting. 

"More eyes are better than one pair, and independent critical thinking by various groups of pathologists yield superior results through shared medical practice experience."  In this light,  telepathology has opened the window for second reviewing support by allowing pathologists all over the world with various levels and degrees of expertise to review diagnostic pathology material, and this has made an even more substantial difference according to the medical literature.  

It is expensive, and in a sense, not routinely practical on a day to day basis, to send ALL pathology cases to selected medical specialists in pathology where on average expense for expert consultation fee is greater than $250 per case. And, studies have shown whereby this might not be necessary to do so. 

While there are many examples, I would like to cite one example in particularly that had a direct impact on me personally.  I sent a case that I was concerned about to a world renown expert in breast pathology.  I expressed my concern to this expert pathologist that the lesion was worrisome for breast cancer both mammographically and clinically, and I felt that there was evidentual support for cancer based on a limited study that I had done on the breast sample, but it was a difficult call to make.  The expert pathologist diagnosed the lesion as "clearly benign without indication of atypical features".  I was still concerned, and documented this as such to the surgeon, indicating to at least follow this patient closely, and perhaps repeat the biopsy sooner than later.  The surgeon repeated the breast biopsy and there was more definitive evidence of invasive breast cancer in this patient, a diagnosis of which I made the second time around with confident, and without resending the case to the expert pathologist.  

I write  to express to you  how MDC-Atlanta, can help you in avoiding such potential negligence because of medical laboratory error.  Often times, in the busy clinic practice, a cursory view of the lab results is made by the busy clinic doctor.  In fact, MDC is here to assist the busy clinic doctor in having a direct communicative and collaborative relationship with an experienced pathologist who could oversee the accuracy and quality of your patients'  laboratory test results, and allow you to have more time for one on one patient interaction.

The ultimate goal of MDC-Atlanta is to digitally connect physician office-based practices with a wide spectrum of specialists around the world, as with a model similar to hospital-based practices, except this practice is online and without walls.  This allows others to join in and present a diverse basis of opinion.   In fact, in this effort, we plan to share tumor cases as well as clinico-pathological correlation presentations live and online with an unlimited participation from physicians around the nation, and perhaps world.  The purpose for doing this is to enhance comradery and educational opportunity among our clinical and laboratory medicine colleagues, as well as to bridge the communication gap between primary care physicians and specialists, explaining how experts in the various fields of medicine practice their specialties of medicine on a day to day basis.  This level of SHARED MEDICAL PRACTICE IS SECOND TO NONE, when experts around the world are able to survey and offer their opinions to other clinical colleagues regarding various medical diagnostic and treatment challenges.  When we have enough participation and interests, we will start these presentations for even patients to participate during the evenings, generally around the 8PM Eastern time.

I look forward to speaking with you regarding the specifics of an engaging relationship between the busy clinic doctor, MDC-Atlanta, and the world of diverse medical specialists.

Sincerely,

Jackson L. Gates, MD

Owner and Founder of MDC-Atlanta.