Last month, we traveled to Mexico’s so-called Riviera Maya. We stayed in a little town called Puerto Morelos, about a half hour south of Cancun. I took some photos of the beachfront there, the neighborhood we stayed in, the Mayan ruins in Tulum and Chichen Itza and a little bit more. Click the photo below for the full photo set.
Detail of El Castillo at Chichen Itza.
Lee Sandlin died earlier this month. What a tremendous loss. He was a fantastic writer, and I was lucky to make his acquaintance. Here’s an obit by Michael Miner in the Chicago Reader, the longtime home for his singular brand of narrative nonfiction.
A celebration of his life and work was held recently at Chicago’s Sulzer Library and his wife, Nina (@nsandlin) — a good friend of mine from our days together at the late, great American Medical News — asked me to contribute some thoughts. Here they are below. I post them here principally for the opportunity to share a bit of Lee’s writerly genius, and to encourage you all to read as much of his work as you can, as soon as possible.
To read is to place your trust in the hands of another, typically a stranger. When you read, the general rule is that most of what you know, what you believe about a subject, what you feel and hear and see in the mind’s eye, is shaped by your guide, the author. There was no better guide than Lee Sandlin.
The road he led you down may have been full of pit stops and detours, but every one was worth all the while. In a world where the written word is defiled by inattentiveness and, worse yet, artlessness, he kept a great faith with himself and with his readers. And, boy, did his prose show you how to go. In “Wicked River,” he wrote:
There were no beacons or lighthouses or channel buoys on the river then; there were no official markers of any kind. Here and there someone would occasionally paint a warning or an arrow on a prominent rock to alert voyageurs to danger — but these were often the work of pirates, to trick boats into going aground. Nor were there any reliable maps. In that era, mapmaking, even at its best, was a mixture of supposition, obsolete or garbled information, and pure fantasy; the first rule of travel in the American interior was that only a fool trusted a commercial map.
But the voyageurs didn’t care. What did they need a map for? The land was so wild it was essentially impassable; anyone who didn’t go by the river didn’t go at all. In effect, the river served as its own map. A voyageur who needed to consult it had only to climb the nearest hill. There the route was unfolded, in all its blue-misted splendor: the great dragon tail of the river uncoiling through forested valleys and across the tallgrass prairies and into the vast shrouded swamps, glittering with ten thousand sunflecks, blurred by drifts of drizzle, blazing with reflected herds of brilliant cumulus, on and on toward the horizon. As far as the eye could see, the river was the only road.
I would give a pinky finger to write sentences so pure, so authoritative, so precise, so true. I feel lucky to have read them, and doubly fortunate to have had the opportunity to share with Lee how much they meant to me, thanks to my friendship with his lovely wife, Nina.
One could call writing like Lee’s majestic, or lyrical, those book-review workhorse words. Posh! I say. When we see nonfiction writing like this again (as will surely be rare), I suggest we call it Sandlinesque. That will be a true compliment. Thank you, Lee, for letting us travel with you. On and on, toward the horizon!
Here it was, the kind of massive postpartum hemorrhage case for which the team at Duke University Medical Center had spent months preparing. The multidisciplinary group had agreed on which laboratory tests would be done in such a case, determined which blood products would be delivered, and decided which members of the OB team would be sent racing to retrieve the potentially life-saving package.
For the two labor-and-delivery nurses designated as runners, the quickest way to get down to the blood bank was the elevator. The elevator was working, but the nurses’ badges did not allow them access to it.
“They had to run all the way down the hall, then all the way down the stairs. It took much longer,” says Evelyn Lockhart, MD, a pathologist who specializes in transfusion medicine and led the Duke team in implementing a massive transfusion protocol for postpartum hemorrhage.
“It was a surprise to us all,” Dr. Lockhart says. Fortunately, the only harm associated with the inaccessible elevator was a couple of winded nurses. That is because the elevator flap came as part of a simulation, and no woman’s life was in danger. It turned out that access to the elevator was restricted to emergency department personnel. That changed soon enough, before any real-life obstetric massive transfusion protocols, or MTPs, were initiated.
The story illustrates an essential truth in the world of massive transfusion, experts tell CAP TODAY. While a randomized clinical trial likely to be published could help answer persistent questions about which blood component ratio can best reduce the mortality rate in massive transfusion cases, experts say that fine-tuning the timely communication, processing, and delivery elements of the MTP are just as essential as determining what “golden ratio” of blood products to prepare.
My cover story from the December issue of CAP TODAY. Read the whole shebang.
So, you have a great idea that will improve laboratory workflow and reduce errors? Chances are the change will depend on automation of some sort, and will involve the LIS. But upgrades to laboratory information systems may not come fast enough, and the middleware may not be available to accomplish what you need. Then the question becomes how to customize the LIS to achieve your aims.
That is what the six-member pathology informatics team at the University of Pittsburgh Medical Center Health System has had to do—work on their own, with middleware providers, and with their LIS vendor to meet the demands of their laboratory colleagues.
“That’s the philosophy we have. Our users ask, and we aim to deliver,” Liron Pantanowitz, MD, tells CAP TODAY. An associate professor of pathology at the University of Pittsburgh School of Medicine, Dr. Pantanowitz also directs cytopathology at UPMC Shadyside, heads UPMC’s pathology informatics fellowship program, and is associate director of Pitt’s Pathology Informatics Division.
Dr. Pantanowitz and his colleague Anil V. Parwani, MD, PhD, detailed several innovative UPMC projects in a CAP ’14 session, “Customizing the Laboratory Information System to Improve Patient Safety and Workflow in the Pathology Laboratory.” These include using the LIS to drive improvements in anatomic pathology quality control, synoptic reporting, and specimen tracking, while exploring the promises—and challenges—of digital pathology and next-generation sequencing.
My latest feature article. Read the whole shebang.
Amid initial confusion over Ebola-related safety protocols for health professionals providing direct patient care, laboratory professionals report hearing a consistent message from the CDC on proper specimen handling. The pressing question for laboratories is how best to approach testing with potential Ebola patients given the dual imperatives of preventing exposure and offering faster diagnostic answers.
My latest in the Put It on the Board section. Read the whole shebang.
The Food and Drug Administration’s plan to subject many laboratory-developed tests to a new layer of regulatory requirements over the course of the next decade is drawing sharply contrasting reactions from stakeholders who view it as either an essential step to improve patient safety or a hindrance that will stifle diagnostic innovation and test improvement.
Despite that fundamental disagreement on the policy’s substance, there does seem to be consensus among informed observers that the FDA is determined to take action, that legislative intervention to block the agency faces long odds, and that the agency’s final guidance will create a regulatory challenge for labs unrivaled by anything out of Washington since CLIA ’88.
My feature article in the October edition of CAP TODAY. Read the whole shebang.
Leading pathologists and the CAP are encouraging laboratory professionals to use the social media website Twitter as a way to amplify lab medicine’s voice among clinicians, policymakers, news organizations, patients, and the public. It is advice that at least one prominent social media expert and nonpathology physician says lab professionals ought to heed.
“Pathologists have a problem being recognized by society because we don’t see patients directly. This is an opportunity for us to get out there in society and to contribute value in that regard,” says Timothy Craig Allen, MD, JD, a newly elected member of the CAP’s Board of Governors and director of anatomic pathology at the University of Texas Medical Branch, Galveston.
My latest in CAP TODAY’s Put It on the Board section. Read the whole shebang.
This month’s CAP TODAY features an all-me edition of the Put It on the Board department. It’s a round-up of three interesting studies relevant to lab medicine. Here are the headlines:
Read the whole shebang.
Newly reported survey data that show widely varying international practices on managing critical values may demonstrate the need for a new guideline—already in development—to help laboratories formulate evidence-based policies.
The new data from European labs were presented during a session at the American Association for Clinical Chemistry’s Annual Meeting and Clinical Expo in Chicago (“Critical Result Management Practices: Global Perspectives and Recommendations for Best Practices”). The session also provided a preview of a forthcoming draft guideline from the Clinical and Laboratory Standards Institute that represents the organization’s first formal attempt to advise laboratories around the world on critical values reporting.
My feature article in the September issue of CAP TODAY. Read the whole shebang.
JIMMY: When you have a serious breakup, putting the Atlantic Ocean between you can be very helpful.
SANDRO: What about the Pacific?
JIMMY: I don’t know. I haven’t tried it.
— Whit Stillman, “The Cosmopolitans“
With Labor Day upon us, it seems appropriate to share another playlist. This one is called “Automobile.” The driving theme seems appropriate because so many people take advantage of this three-day weekend to take driving trips. Unfortunately, the song that inspired the title — John’s Prine’s “Automobile” — is not available on Spotify. Here’s Prine playing it live in a 1980 televised concert. Song starts about 1 minute, 40 seconds in.
Anyhow, here’s the rest of the playlist. I had to make a couple of substitutions, again due to Spotify: a Bluegrass version of “Cut Every Corner” from The Simpsons, and John Hartford doing “Turn Your Radio On” instead of Grandpa Jones.
Time is running short for laboratories to figure out how they will comply with a federal regulation that for the first time requires all U.S. labs to give patients their test reports within 30 days of request.
With the Oct. 6 deadline for complying with the mandate fast approaching, leaders at two laboratories shared how they are wrestling with the regulation during a July 31 webinar hosted by G2 Intelligence.
A process that at first blush may seem fairly straightforward—patient requests test results, lab hands them over—gets complicated fast. How does a patient request the test reports? How does the lab that conducted the test verify the identity of a patient, or of a patient proxy, who may live in another state? And how should labs handle patients’ access to sensitive test results relating to sexually transmitted infections, or life-changing diagnoses?
My latest in CAP TODAY’s Put It on the Board section. Read the whole shebang.
Payment rates declining. Bad debt rising. Test orders falling. Diagnostic equipment manufacturers checking in on test-volume commitments. A wrenching transition from fee-for-service care to population-based medicine. These are a few of the trends that laboratories across the country are seeing and that keep lab directors up at night, heavy lidded, checking their email, illuminated by the glow of their smartphones.
Strategies that once reliably yielded success in the laboratory business are no longer sufficient, says W. Stanley Schofield. He is president of NorDx, which operates 11 labs and 23 patient service centers and is owned by the MaineHealth system, also affiliated with four other health care organizations in the state. Schofield is cofounder and managing principal of the Compass Group, a 501(c)(6) business league whose 24 lab members represent more than 300 of the nation’s most prestigious hospitals and health systems.
Labs are being called upon to simultaneously add value, cut costs, and improve the quality of the work they do, Schofield says. Moreover, the pressure is on for laboratories to show how their performance compares with that of their peers.
“Today, labs are known for, and their value is seen to be in, delivering accurate test results in a timely fashion,” Schofield tells CAP TODAY. “In the future, the value of the laboratory is that it will help manage that the right test was done on the right patient for the right reason, and that the right cost will be available. And that they manage the data, rather than just report the data. That is one of the huge transitions that labs have to go through right now, and that we are preparing for.”
My cover story in the August issue. Read the whole shebang.
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