CEO SUMMARY: Each year since its launch in 2001, the ASCLS Consumer Response Team serves increasing numbers of patients and physicians. Clinical Laboratory Scientist volunteers from the American Society for Clinical Laboratory Science provide answers and help patients understand the meaning of their lab test results. After sending a question by e-mail, these patients get answers within 24 hours. This non-commercial, peer-reviewed, patient-centered site is helping fill a gap in care delivery.
MOVE OVER “LAB TESTS ONLINE!” There is another big success story in how laboratory medicine serves consumers. It is the Consumer Response Team organized by the American Society for Clinical Laboratory Science (ASCLS) of Bethesda, Maryland.
ASCLS organized its Customer Response Team in 2001, in support of the “Lab Tests Online” (www.labtestsonline.org) Web site. Lab Tests Online was created by a consortium of lab industry organizations. It is a non-commercial, patient-focused site which provides information to patients about any and all clinical laboratory tests.
When visiting Lab Tests Online to seek information about the meaning of their lab test results, consumers have the option of sending questions to the ASCLS Consumer Response Team. On the Web site, there is detailed information about most laboratory tests. Prepared responses can be found for common questions. If the patient or consumer wants to submit a question by email, he/she will receive a response from a clinical laboratory scientist within 24 hours. Neither Lab Tests Online nor the ASCLS Consumer Response team accepts phone calls.
A team of 50 clinical laboratory scientist volunteers manages the Consumer Response service. These individuals work in a wide variety of fields in labs nationwide. The ASCLS says those answering the questions are some of the best and brightest lab scientists working today.
More People Visiting The Site
When the Lab Test Online Web site became active in 2001, consumer questions came in a slow trickle. However, the number of patients, physicians, and consumers visiting www.labtestsonline.org grew steadily. Currently, every day the ASCLS Consumer Response Team receives about 115 e-mail queries—almost 42,000 per year! Many of the same volunteers who started answering the questions in 2001 still do so today.
“In recent years, we’ve seen the number of questions increase steadily,” said Susan J. Leclair, Ph.D., CSL(NCA), the Chancellor Professor in the Department of Medical Laboratory Science at UMass Dartmouth and the chair/leader of the Consumer Response Team. “One reason for this increased activity is that patients are becoming more interested in their own care. Another reason is that the time physicians spend with patients has been cut sharply.”
Doctors Submit Questions
Leclair is responsible for quality control at the ASCLS Consumer Response Team. In that role, she reads every question and every answer. Leclair says that it is not only patients who use the services of the Consumer Response Team. An increased number of physicians are submitting questions.
“This increase in provider e-mails came just within the last year,” observed Leclair. “Previously, we got very few from physicians—maybe 1% or 2% of the total. Currently, questions from physicians now represent about 5% to 8% of our total.
“Questions from physicians tend to center around such topics as the complexity of testing, how to interpret results, the limits of some tests, the volume of testing, and recently introduced tests,” she commented. “In general, the most common format for a question from a provider is first a thumbnail sketch of a patient and then a statement about test results that he or she does not understand.
Resource For Physicians
“Sometimes physicians ask about tests that are uncommon,” she continued. “They want confidence in how to interpret the results. The high sensitivity c-reactive protein test is a good example because it is better than the sedimentation rate for evaluating inflammation. The doctor wants to know, ‘How do I use this information?’ Clinical practice is moving from a test (sedimentation rate) that was around for a very long time to a slightly newer, better, more specific test (c-reactive protein). Physicians want confidence that they are ordering the newer test appropriately and interpreting the results accurately.
“We are an adjunct to the more tradi- tional way of getting information,” Leclair said. “If a pathologist works an 8- or 10- hour day, he or she is likely not available at 10 p.m., just when a physician reviewing test results needs an answer. That’s another aspect that makes the Lab Test Online service useful: It’s available 24 hours a day.
“I believe two major forces drive the growing patient and provider interest in this service,” she added. “First is the sea of change in the way patients look at healthcare, particularly in the United States. When our parents went to the doctor, they listened to what their doctor said and there was not much else to discuss.
“That rather passive nature of patients has changed,” continued Leclair. “Starting in the 1990s, people began to tell their doctor, ‘Don’t just give me your diagnosis and treatment plan. You need to give me facts, figures, and support for everything you’re telling me.’
Less Time With Patients
“Second, also in the 1990s, and predominantly in the United States, was the influence of managed care,” Leclair explained. “As managed care attempted to cut costs, physicians found themselves with a limited amount of time to spend with patients. Now the average physician has only seven minutes with each patient. That’s not enough time for a discussion about lab test results or any other aspect of patient care.
“This was also the time that patient support groups started forming on the Internet,” she continued. “One of those groups was the Association of Online Cancer Resources (ACOR). It formed in the mid-1990s because patients were seeking more information than they could get from physicians.
“It was this type of patient for whom we designed the ASCLS Consumer Response Team,” Leclair said. “One joke you will hear on ACOR is that the most common ailment that cancer causes is deafness. This describes the reality of a patient at the time of an unwelcome diagnosis. When a patient hears the word ‘cancer’, they hear very little of what the physician says next.
“Then they go home and stew for a while,” she stated. “But after 24 or 48 hours, they have many questions. So if the next doctor’s appointment isn’t for two weeks or two months, we can fill those information gaps for them. When their physician says something in ‘medicalese’ we can provide a translation.”
Leclair says that patients from all around the world visit the Lab Test Online Web site and submit questions to the ASCLS Consumer Response Team. “It’s possible to ask a question in Czech, German, Greek, Hungarian, Italian, Spanish, and Polish. We get the question translated and send an answer back in the native language,” noted Leclair.
Most Frequent Questions
What questions are asked most frequently? “Biochemistry—including blood sugar tests and lipid studies for cardiovascular disease—probably make up the largest volume of inquiries,” Leclair said. “We also get many questions about cardiovascular tests, such as blood cholesterol and lipoproteins. Questions come in about thyroid disease, HIV status, and hematology—particularly as it relates to anemia. Recently we’ve even seen a surge in questions concerning fertility studies and hormone levels.”
While Leclair and the other volunteers can answer many different types of questions, some are beyond the reach of clinical lab science. Patients and physicians who ask such questions are referred to other sources.
“If any question is beyond our scope, I explain that the service is designed to help patients and others understand their laboratory test results,” Leclair said. “If I know where they need to go, I will refer them to the appropriate clinician or other provider resource. Otherwise we just tell them to use Google or other general medical search sites and to be careful about what they read.”
THE DARK REPORT observes that the ASCLS Consumer Response Team is one of the hidden gems of the clinical laboratory industry. It is a much-needed channel that allows consumers and patients to directly interact with laboratory medicine professionals.
Lab Tests Online Helps With Communication Gap
BRIDGING GAPS IN COMMUNICATION between physicians and their patients is a common service provided by the Customer Response Team, the Internet information service managed by the American Society of Clinical Laboratory Services (ASCLS).
“Often, physicians explain things using a medical shorthand that patients don’t understand,” said Susan J. Leclair, Ph.D., CSL(NCA), the Chancellor Professor in the Department of Medical Laboratory Science at UMass Dartmouth and a volunteer at Lab Tests Online.
“A patient can have an abnormal complete blood count, for instance, and the physician will get the result and say, ‘Fine,’ and then tell the patient to take iron pills. That’s a common example”, observed Leclair.
“Then the patient will write to us and ask, ‘How can my physician say, ‘Fine,’ when I have these unusual ranges?’ What the physician meant was the lab test confirmed a diagnosis based on other information from the patient. Now the physician knows what to prescribe. In that sense, saying, ‘fine,’ is the physician’s shorthand for verbalizing the entire thought process with one word. As clinical lab scientists, we can provide the translation.”