Marianne T. Downes, PhD, MLS(ASCP)CM, ASCLS-Pennsylvania President

I am no one special. I did not spend my entire life planning to work in a hospital laboratory. I did not even know the field existed until someone informed me of the appropriate education and credentials needed to successfully enter this field. However, during my MLT and MLS educational experiences, it became quite clear to me how deeply impactful our work is on the lives of individuals, on the reputations and bottom line of our employers, and our role in public health.

Still, I was not seeking any type of management opportunity or responsibility. I simply wanted a career where I had a high degree of job security that would allow me to provide for my family. I further wanted a job that I could be proud of and would allow me to feel like an important part of society, but I had no desire to “rock the boat” or be recognized in any way. I just wanted to get the work done and get it done right. There are quite a few people working in clinical laboratories who have similar goals and who may not feel empowered to labvocate.

“If you don’t speak up, someone else will speak for you, and it may not be someone with your best interest in mind.”

In my experience, labvocacy snuck up and appeared in surprising ways. For me, it started with teaching family and friends about laboratory testing, results, and interpretation, as well as the importance of maintaining specimen integrity to the accuracy of testing results. The most surprising labvocacy moment came when I appeared before a district magistrate over a speeding violation in Pennsylvania.

While dealing with my own traffic citation, I had the opportunity to challenge and change an interpretation of law by educating both the magistrate and the state police officer who had issued my speeding citation about specimen collection, specimen preservation, and the validity of blood alcohol concentration (BAC) test results completed on properly collected and stored specimens. They had been influenced by the voice of one savvy defense attorney who was not an expert in biomedical diagnostics. Due to the lack of the laboratorian’s voice, dozens of valid BAC results had been disregarded and charges dismissed prior to my chance encounter. All I needed was my own educational background and certification to qualify my voice as a labvocate. At that time, I had less than one year of work experience, yet I was able to make a positive impact.

How many times are decisions made that impact the way in which laboratory testing is performed, billed, or handled? Are these decisions being made by people who understand medical laboratory diagnostics? Who are the decision makers listening to? When there is no counter argument, decisions are influenced by the voices that are heard. Because of this, I decided that I needed to educate elected lawmakers about concerns revolving around the laboratory and patient safety.

The current pandemic has created ample opportunities to labvocate. As an example, in the face of COVID-19 testing backlogs, some lawmakers proposed not paying for testing that took more than 24 hours to be resulted. The proposed solution is not useful, but if lawmakers are being told that testing can be completed in 15 minutes and be accurate, do they have enough information to understand why test results may not have been available for a week or more after collection? These lawmakers are reacting to the voices they hear and the information that is presented to them. We need to ensure that they hear the laboratory’s voice so that they can make informed decisions.

Whose voice are you going to allow to influence the future of the medical diagnostic laboratory? There are 100 senators in the U.S. Senate and 435 voting members of the U.S. House of Representatives. For the 116th Congress (January 3, 2019, to January 3, 2021) 96 percent of the members held college degrees; however, few of those members held degrees in science and fewer still in medicine or a related field. Therefore, the majority of those with the power to write and vote on national legislation, which affects how you perform your work and the personnel requirements of all of those who can perform clinical laboratory testing, do not have the background or expertise to understand the complexity or impact of our work on quality patient care.

Within each state, there are lawmakers and agencies which further dictate/manage clinical laboratory diagnostics and the personnel who can perform that testing. The laws and guidelines for this are as diverse as each individual state; however, in each case, those voting on the laws are reliant on us, members of the profession, to inform them of our concerns and recommendations to assure quality and safe patient care. Who will influence these decisions of lawmakers? Lobbyists for patient advocacy groups? Hospital CEOs? Medical insurance companies? Large corporate diagnostic labs? Medical worker unions? Do those groups’ interests align with yours? Sometimes they do, but sometimes they do not, and it is important that their voices are not the only ones heard.

If you don’t speak up, someone else will speak for you, and it may not be someone with your best interest in mind.

Marianne T. Downes is Associate Professor of Biomedical Laboratory Diagnostics in the West Virginia University School of Medicine Professional Programs Department of Pathology, Anatomy and Laboratory Medicine in Morgantown, West Virginia.