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Who Reports Complex Test Results?

From George: Here is a recent message from a colleague who asks about a common but awkward professional issue related to reporting complex test results:

I work at a small anatomic pathology laboratory that provides services almost exclusively to oncologists in a major metropolitan area. Coagulation is the only department in the lab that is not considered to be “pathology.”  I am the only technologist in the coagulation lab, and while our menu is fairly robust (a full thrombosis panel and von Willebrand testing), our volume is not. Because most of our patients are anticoagulated, lupus anticoagulant panels can be difficult to interpret. Due to the amount of surgical and hematopathology work our two pathologists have, I am expected to interpret all lupus anticoagulant panels, regardless of my experience, knowledge, or confidence. Unfortunately, it’s become very difficult to motivate my medical director (the only pathologist here with coagulation knowledge) to assist me in these interpretations.

Do you know what the requirements are, if any, for a pathologist to provide interpretations for lupus anticoagulant testing? As the medical director and the sole reason we have a coag lab, I feel it behooves him to be involved, at least at a minimal level. I have no problem interpreting negative panels or unambiguous positives, but it gets dangerous when results don’t correlate or the patient is on one of the novel anticoagulants. I can’t seem to find any sources suggesting the liability could be entirely shouldered by an uninsured technologist. I have involved my manager, but since he has no experience in coag it is difficult for him to understand the complexity of these panels.

I turned to Larry Brace, PhD, who consults with several Chicago facilities and is familiar with reporting regulations. Here is Dr. Brace’s response.

George asked me help with your question. Interpretation of lupus panels is something that pathogists charge for. You can provide advice to the pathologist but the interpretation must “signed out” by the pathologist. You should not be putting any comment or interpretation into the computer/patient record. You do not have the credentials to do so, and do not have medical liability insurance for this. If you are entering interpretation of test results, you are subjecting you self to medical liability claims. You do not want to do this. That is the job of the pathologist. I hope this helps.

Thanks to Dr. Brace for his assistance. I’d like to know if this is how complex testing reports are generally managed in acute care facilties in the US, and whether reporting is managed differently outside of the US. Please post your comments here.


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