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Outside the Lab Profession, Point of care testing, COVID-19

The Social Justice System

My journey to Montefiore began almost 30 years ago. In 1992, I was recruited to be the Associate Director of Pediatrics at Jacobi Hospital, an affiliate of Montefiore Medical Center and a teaching hospital for the Albert Einstein College of Medicine. In 1998, inspired by the legacy of its commitment to the use of health care as an instrument of social justice, I moved over to Montefiore to serve as Chief of the Division General Pediatrics.

Montefiore serves a largely poor, underserved, and diverse population of people from across the globe. In that regard, our pathologists see many unique cases and diagnose diseases that pathologists in other areas of the United States may never see. The demands on our department, due to both the volume of illness we see and the breadth of conditions presenting in our patients, make this a department unlike any other in the country. We see both first-world diseases and those that originate in developing countries – and being alert to all possibilities distinguishes the work our pathologists do every day.

But these are not the main things that set the pathology department at Montefiore apart from its peers. What makes our pathology department unique is its people. Like those of us in other areas of clinical medicine, the pathologists who come to this institution do so out of a drive to support an underserved community. This manifests itself in a commitment to delivering the highest quality of laboratory and pathology services to the greatest number of our patients in the most reliable and efficient manner possible.

The Montefiore Einstein pathology department is committed to bringing the most cutting-edge technology to bear on clinical challenges so that the poorest patients in the country benefit from some of the most advanced systems available. Tackling the disparities that are prevalent elsewhere through the application of these systems is a key contribution our pathology department makes to the delivery of care in New York City, in our region, and beyond.

Our colleagues in pathology demonstrate not just a willingness, but a distinct appetite for involving themselves in every aspect of the delivery of care at Montefiore.

Medicine is a team sport. Within that team, each of us has a distinct role to play – and because we depend on one another for the team to function at its best, we revel in one another’s excellence. Being able to rely on the precision, timeliness, and accuracy of the findings emerging from the Department of Pathology makes our clinicians better and ensures that our patients benefit from the concerted application of medical science at its finest. That said, our colleagues in pathology demonstrate not just a willingness, but a distinct appetite for involving themselves in every aspect of the delivery of care at Montefiore, up to and including our devotion to population health. This makes them – and you – much more than just “the folks behind the machines in the lab.”

Pathologists are, first and foremost, physicians. Like all physicians the qualities that distinguish good pathologists are devotion to their craft (which means a commitment to both the science and the art), devotion to their patients, devotion to their colleagues, and an awareness of the part they play in the delivery of care. Our pathology faculty and trainees exemplify all these qualities and strengthen the institution far beyond what happens within the confines of the laboratory.

The dedication and expertise of our pathology faculty and trainees were critical in our ability to respond to the challenges of the initial wave of COVID-19 in spring 2020. The scarcity of PCR test equipment and reagents placed extraordinary strains on the institution’s ability to triage patients and determine where and how to treat the waves of sickness arriving at our doorstep. Our pathologists’ resourcefulness in setting up testing equipment overnight, seeking new physical spaces to conduct tests, sourcing adequate reagent supplies, and rapidly turning around test results made it possible for Montefiore to position itself at the forefront of testing, and therefore of treating, the enormous volumes of patients who fell ill at the outset of the pandemic. Without their contributions, our response would have been crippled and our ability to handle the vast amount of illness irretrievably constrained.

The pathology department’s contributions to Montefiore’s COVID-19 response is just one example of its vital role in the functioning of this complex institution. Another is augmenting the reach of our nationally recognized school health program.

The Montefiore School Health Program was founded in the 1980s by David Appel, a physician in the Departments of Pediatrics and of Family and Social Medicine. It now serves tens of thousands of students in over 100 schools throughout the Bronx. The Department of Pathology was instrumental in securing COVID-19 point-of-care testing (POCT) in many of these school health practices, bringing sophisticated testing platforms directly to the venues where they could do the most good.

By carefully tracking POCT trends in our EDs, we gain a window into the trends of disease prevalence in the population coming to us for care.

The positioning of POCT in schools, as well as in our emergency departments, enables us to rapidly diagnose COVID-19 infections and apply contact tracing and isolation effectively to limit the spread of the disease. It also decreases the amount of time COVID-19 patients spend in our emergency departments (EDs) by allowing rapid decision-making regarding bed assignments. In addition, by carefully tracking POCT trends in our EDs, we gain a window into the trends of disease prevalence in the population coming to us for care and can therefore predict the course of the pandemic at our institution more accurately.

Finally, the Department of Pathology helps us address the pressing issue of healthcare disparities. Race-based testing for certain categories of illness has, over time, exacerbated healthcare disparities, particularly with respect to African Americans. Our pathology department has worked in coordination with others – for example, our division of nephrology, with whom they revised the eGFR measurements we use to eliminate the race-based aspect of this laboratory metric. In addition, by providing POCT via our School Health Program, the department has lessened disparities in access to cutting-edge diagnostic technologies. Now, schoolchildren in the Bronx have equal – or perhaps superior – access to diagnostic testing compared with other populations.

For these reasons and many more, I am delighted to have been given this opportunity to express my pride – and our pride as an institution – in the skilled and dedicated practitioners of laboratory medicine with whom we are fortunate to work, day by day, side by side, to improve health outcomes and quality of life for a diverse and underserved patient population. I hope that other institutions will see Montefiore Einstein as an inspiration to follow – and, of course, we’re happy to answer questions and offer advice at any time!

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About the Author
Andrew D. Racine

System Senior Vice President and Chief Medical Officer, Montefiore Health System, and Executive Director, Montefiore Medical Group, Bronx, New York, USA.

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