The Ignorance of Laboratory Medicine

I was recently at a meeting where a pathologist said, “We have to continually re-educate our clinical colleagues about what it is that we do in laboratory medicine.” At that same meeting, a different pathologist shared his frustration that clinicians were making decisions about their electronic medical records without input from laboratory medicine.

Why do clinicians seem to have a persistent lack of knowledge about when and how to collaborate with laboratory medicine?

Certainly, these are frustrating situations, but more importantly, they may limit our ability to support the mission of our hospital. I would like to reflect on this "ignorance" of laboratory medicine. As a word, ignorance carries a certain weight. I’m not suggesting a malignant motive by clinicians, but rather, observing a lack of knowledge that seems to permeate throughout medicine.

Considering that physicians rarely see a pathologist in everyday clinical life, I can appreciate how easily the illusion of knowledge may be established. Out of sight, out of mind. The other week I finished the book, The Knowledge Illusion. In it, Steven Sloman and Philip Fernbach describe how little we actually know, relative to what we think we know. They do a particularly nice job of explaining both the negative and positive aspects of this reality.

One of their takeaway points is, “The problem is not ignorance per se. It’s the trouble we get into by not recognizing it.”

This resonated with me, as it is relevant to our challenge in laboratory medicine.

Given that we are constantly re-educating colleagues, more knowledge doesn’t seem to be fixing our problem. Slomen and Fernbach would suggest that the opportunity here is to re-structure our environment to enable good decisions based on community knowledge. In other words, laboratory medicine will always be a “blind spot” for clinicians, so ensure that laboratory medicine specialists are represented in hospital leadership decisions. This way, we may avoid ignorance from taking us, our hospitals, and patients on a less-than-ideal course.

Dr. William J. Mayo once said, “The internist, the surgeon, and the specialist must join with the physiologists, the pathologists, and the laboratory workers to form the clinical group.”

Dr. W. J. Mayo was wise to understand that it is not about knowing more than everyone else. The key is to effectively manage what we don’t know by collaborating with those who do. What are our "blind spots"? How can we become more aware of the knowledge that lives in our larger community? Please take a minute to ponder these questions, and then comment below.

Justin Kreuter

Justin Kreuter, M.D., is a clinical pathologist at Mayo Clinic in Rochester, Minnesota. His practice consists of both general and subspecialty aspects of clinical pathology. At Federal Medical Center-Rochester, Dr. Kreuter runs the general laboratory that supports a local in-patient population and does a large amount of reference work. At Mayo Clinic, Dr. Kreuter's time is split between the transfusion medicine service and transplant laboratory. In addition to clinical activities, his academic interests include several aspects of medical education, including teaching clinical judgment, frameworks for feedback, and reflection in medical practice.