I can't get no satisfaction

The Rolling Stone's biggest hit from 1965 was "I can't get no satisfaction".

Over 40 years later the song comes to mind when reading about pathology errors in Canada that have eroded public confidence. Although about Canada, the events and resulting news coverage should resonate in many countries.

Chorneyko K, Butany J. Canada's pathology. (editorial) CMAJ 2008 Jun 3;178 1523

The authors, one of whom is the president of the Canadian Association of Pathologists (Butany), acknowledge that "Canadian laboratories are not unique in facing workload and human-resource issues or problems pertaining to medical error and patient safety" and then note that Canada lacks a national quality assurance (QA) program such as the College of American Pathologists in the USA and similar organizations in the UK and Australia.

Unfortunately, they mention only Ontario and BC as having laboratory accreditation and proficiency testing programs, when other provincial programs exist, including what is arguably the longest functioning and very effective QA / proficiency testing program of the College of Physicians and Surgeons of Alberta, including an excellent program for transfusion medicine.

Related news items that subsequently appeared include

• Diagnostic cracks in our health care

This article begins, A horrendous series of blunders at a Newfoundland medical laboratory has raised a frightening thought: What if similar problems exist at other facilities across the country?

• Canada lags in standardized protocols for medical labs
• Pathologists respond to criticism after breast cancer testing errors

Several stories in national papers have erroneously reported that only Ontario and British Columbia have regulatory bodies with authority over medical laboratories, e,g.,

• Pathologists call for national system to prevent testing errors (National Post, 16 July 2008)

The National Post reports that the Canadian Association of Pathologists has called for a national diagnostic checklist to include test validation, staff training, competency assessment, standardization of operating procedures and equipment maintenance. These measures have been standard practice in transfusion and other clinical laboratories for years.

The news coverage creates the impression that Canadian labs put the public at grave risk.

To date some pathologists and laboratorians have commented:

• Swaine FB, Hannon JL, Clarke G, McBride E. Medical labs must meet standards (letter to the editor, Edmonton Journal, 19 July 2008)

Swaine, et al. point out that in Alberta laboratory accreditation and proficiency testing programs have existed since the 1960s and are administered by the College of Physicians and Surgeons of Alberta.

• Ford J , Wadsworth L. Pathology practice in Canada. CMAJ 2008;179:342

These authors focus on clinical pathology and the need to fund and resource laboratories adequately.

VISIBILITY AND STATUS OF PATHOLOGY and LABORATORY MEDICINE

Laboratory technologists / clinical laboratory scientists / biomedical scientists constitute the 3rd largest group of health care workers, yet lab medicine as a career has long suffered from

• low salaries (typically much less than nurses, which have a higher visibility)
• limited upward mobility
• poor understanding of the profession by the public and other health professionals

For example, most patient exposure to the lab is via blood collection. Few know that lab workers are well educated and skilled professionals who operate sophisticated equipment, problem solve, and work with physicians to help to diagnose illness. See

• Raising awareness of clinical laboratory science

I have heard pathologists say that they too are often under-recognized and near the bottom of the respect ladder in medicine making recruitment difficult. For example, see

• Blumberg N, Albert M, Krabill K. Pathologists are doctors (letter). Ann Intern Med 1993 Apr 1;118(7):575.
• Davis GJ, Lantz PE. Pathologists are doctors (letter). Ann Intern Med 1993 Apr 1;118(7):575.
• Inoshita T. Pathologists are doctors (letter). Ann Intern Med 1993 Apr 1;118(7):575.

• Who is the pathologist?

• Pathology as a career

BOTTOM LINESerious pathology-related errors occurred, indicating a problem. The concept of a national body developing laboratory quality standards has merit, so long as any new program integrates with existing provincial programs and does not create another layer of bureaucratic regulation. All provinces need to develop functioning accreditation programs and existing provincial systems can be improved - hence the concept of continuous quality improvement.

However, the overall notion that Canada's clinical laboratories are uncontrolled back-waters of laboratory medicine that generate test results of poor quality is wrong. Additionally, headlines implying incompetence do not help desperately needed recruitment and undermine the professional pride and status of pathologists and laboratorians.

"I can't get no satisfaction" from the pathology lab errors in Newfoundland and Labrador, which likely led to incorrect treatments for almost 400 breast cancer patients.

"I can't get no satisfaction" that laboratory medicine has poor public visibility and is only marginally understood.

"I can't get no satisfaction" that laboratory professionals suffer from a lack of status among other health professionals.

"I can't get no satisfaction" from a possible public misconception of widespread clinical laboratory incompetence, especially as a blood banker. In Canada and in most countries transfusion medicine has led the way in implementing quality systems in clinical laboratories.

Of course, satisfaction should be internally generated and lab professionals are indeed dedicated to patient safety and intrinsically proud of their role on the health care team.

Keith and Mick got it wrong when they wrote:

I can't get no satisfaction
I can't get no satisfaction
'cause I try and I try and I try and I try.....

It's better to view satisfaction the way Mohandas K. Ghandi did:

• Satisfaction lies in the effort, not in the attainment, full effort is full victory.

I'll go with the Mathatma for now....

Related resources

• Lab tests Online