Posted by Sten Westgard, MS
Why do some numbers and statistics in the laboratory attract more attention than others?
While we consider ourselves scientists who make decisions based on rational cost-benefit analyses, an objective look at some of our priorities often reveals the opposite. Labs often make decisions and set priorities based on the emotions of the moment, rather than a cold analysis of the data.
Let's put it another way. There is an infamous quotation attributed to Stalin: "When one man dies it is a tragedy, when thousands die it's statistics."
Do labs respond more to individual tragedies or their own statistics?
In the first case, Traceability, Harmonization and Standardization is undoubtely one of the most important issues facing the laboratory. Yet it is very rare that I find a laboratorian expressing personal concerns about the traceability of their method. It's an issue many people acknowledge, but it's an abstract problem, not one that they feel personally concerned about. When a great deal of the work on Traceability is being conducted by expert committees, it's easy for the individual lab or laboratorian to feel distant from the struggle and powerless to make any impact.
On the other hand, pre-analytical errors are a local crisis impacting labs every day. Missing specimens, swapped specimens, mislabeled specimens, etc., these are the events that strike horror into every self-respecting laboratorian. We are in an era right now where the paramount concern is the pre-analytical error - you see a lot of papers and topics devoted to these topics right now.
Now, stop for a moment and consider the scope of the two problems: our studies on Traceability and Trueness have found that we have methods on the marketplace whose every result is significantly in error. The studies find that there are significant discrepancies between methods such that patients whose care spans multiple health systems are impacted by shifts in test results that aren't a result of their health status, but are only a result of method differences. Pre-analytical errors, on the other hand, even when they happen frequently, typically impact just one or two specimens at a time.
So why do pre-analytical errors take a bigger place on the stage?
In the book, The Upside of Irrationality, author Dan Ariely notes that there are three psychological factors that determine how much attention we give to a subject: Proximity, Vividness, and ability to make an Impact. Problems that are close to us, vivid in their impact, but can still be influenced by our individual actions, are problems that we take to heart. We pay more attention to them. On the other hand, problems that seem distant, vague or abstract, and seem so intractable that our individual actions won't make any impact, are problems that we place at a lower priority.
Pre-analytical errors are perfect examples of emotional appealing problems: they are right in our own laboratory. They are vivid, because we can identify individual specimens, and even possibly individual patients, who are affected directly by the error. Finally, we can usually fix these errors: the problems in pre-analytical processes are often within our grasp to solve. Additional training, re-design of specimen handling, or a modest investment in technology and/or automation, can make palpable improvements to the pre-analytical error rate.
Traceability issues, in contrast, are an example of daunting "I can only be a drop in the bucket" challenges. The problem is not in our laboratory, it's spread out across all laboratories. And the problem doesn't affect just a single identifiable specimen - it's an impact that is happening to possibly thousands or millions of specimens, with consequences we may not be able to measure. Finally, how does one laboratory fix the Traceability problem? It can't. It takes manufacturers and metrologists and ISO standards and an industry movement to solve this problem.
This is not to disparage the importance of pre-analytical errors. We prefer not to think in zero-sum terms here: just because one error is getting attention, doesn't mean we should neglect to pay attention to other types of errors. We need to fix both pre-analytical processes and the Traceability of laboratory tests (and analytical errors and post-analytical errors, etc.).
That's the real point here. Remember that the most vivid error isn't necessarily the error that makes the biggest impact on your test results. We have to temper our emotions so that we are addressing all the important errors and problems in the laboratory.
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