Laboratory Lessons in Conflict Resolution

Laboratory practice is usually centered on generating quality results for clinical decision-making. Ethical issues are infrequently encountered and often overlooked. It is true that some of the more common ethical considerations – autopsy consent, retention and use of biological material, and medical error disclosure, for example (1) – are recognized and addressed during laboratory training programs; however, training rarely covers issues encountered during routine laboratory testing, including conflicts with clinical staff, inappropriate test utilization, tests ordered on patient specimens without consent, or the use of clinical specimens for legal or forensic purposes (2). The knowledge and skills required to resolve these issues are difficult to teach – especially as problems with far-reaching ethical issues seem to present to laboratory staff only sporadically.

Our laboratory recently faced a problem regarding test turnaround times for a secure youth detox and stabilization program. The program involves arrest, medical assessment, laboratory testing, and detention in a secure facility for troubled youths at risk of serious harm. Many services, groups, and individuals are involved in this sensitive process, including police, psychiatry, addiction services, child services, emergency departments, hospital security, courthouse staff, and the youths’ family – all of whom obviously have very different, yet equally valid, perspectives on the program’s benefits and challenges. One delay that was singled out involved the reporting of rapid urine drug screens from the hospital laboratory. Clinical staff considered these tests essential for decision-making, but felt they weren’t receiving results in time – a laboratory problem. To help address this concern, we began to participate in the multidisciplinary team meetings, a setting where so many disciplines and perspectives are represented that conflicts are inevitable. Fortunately, we were able to use our laboratory expertise to ensure that forensic-quality lab methods and test results were part of the solution. The forensic-quality drug tests were not rapidly available, but the quality of those results was important for both the patients and our medical team – so we consistently ordered them, as well as more rapid testing to minimize the time that patients and security personnel spent in the emergency department.

As a pathology trainee, this hands-on experience was a valuable way to identify ethical issues, acknowledge and address our colleagues’ concerns, and see conflict resolution in practice. Having previously worked both in family and emergency medicine, as well as in laboratory practice, I have seen both sides of the clinical-laboratory divide. As laboratory practitioners, I feel it is essential for us to bridge the divide by leaving the confines of the laboratory, joining discussions with our clinical colleagues, and helping shape health care in our facilities. The communication skills to successfully collaborate with multiple disciplines require practice and experience – so, in my opinion, trainees should be involved in these sometimes difficult situations as part of training programs to help them develop the necessary skills and promote collaboration, positive interdisciplinary relationships and leadership (3). Our work with the youth program also reminded me and my colleagues that our primary focus should be patient care; many of the patients involved have significant challenges. As laboratory professionals, we need to be cognizant of our role as directors of laboratory services, prompting the right tests at the right times. We do not serve patients by simply cancelling tests, or by passing the obligations on to our clinical colleagues. We can play an important role in health advocacy by bridging the gap between clinical and laboratory expertise – but only if we are prepared to develop successful communication and teamwork outside our laboratories. With easy access to results through electronic medical records, easy access to information via “Dr. Google,” and the increasing adoption of point-of-care testing, the argument for better communication and teamwork will only grow.

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