Medical Laboratory Scientist – Laboratory Physician Impasse: Finding a Lasting Solution

Introduction
The Medical Laboratory Scientist-Laboratory Physician stand-off has been in existence for over a decade. Recurrent episodes of this conflict has led to disruption of patient care in hospitals over the years. The main bone of contention is, which of the two of groups should be reposed with the authority for leadership and governance in the laboratory. This article seeks to discuss the issue and offer recommendations.

Korle Bu Teaching Hospital Central laboratory

The Central laboratory of Korle Bu Teaching Hospital (KBTH) is accredited by the international standard organization (ISO).
The Medical Laboratory Scientists who currently work there have degrees in Medical Laboratory Science ranging from Diploma, Bachelor of Science, Doctor of Medical Laboratory Science, Masters and PhD and are licensed by Allied Health Professions council. Also, there are Fellowship holders from the West African Postgraduate College of Medical Laboratory Science.

Arguments by KBTH Doctors Association ( KODA) and Rebuttals from Medical Laboratory Scientists

The Leadership of KODA have publicly made the following arguments:

1. Most laboratory reports from the Central laboratory do not correspond with clinical findings with inconsistencies reaching as high as 50%.

Rebuttal from Medical Laboratory Scientists:

This claim is false and not backed by any empirical evidence. The tests available at KBTH are referred to private facilities mainly for financial benefits of the persons issuing the requests.

2. Laboratory reports needs to be cosigned by Lab physicians

Rebuttal from Medical Laboratory Scientists:
The co-signing of Medical Laboratory Reports by Physicians is not mandated by any regulations in Ghana nor the ISO 15189 : 2022.

3. The Laboratory physicians should be granted access to the Laboratory.

Rebuttal from Medical Laboratory Scientists:

1. To practice in the Medical laboratory, you must be licensed by Allied Health Professionals council of Ghana (Act 857).
The request for unrestricted access to the laboratory by KODA is seen by Medical Laboratory Scientist as employing a principle in Social Psychology called ‘Foot- in-the-door technique’
By this method, a party is made to agree to a minor request with a high probability of agreeing to a Major request later.
Medical Laboratory Scientist believe strongly that, granting unrestricted access to the laboratory, their practice would be hijacked by Physicians with a high risk of extinction or irrelevance of the profession in the future. Lessons have been learnt from the fate of some sister professions in the country.

Accreditation Status of Consulting rooms, Theatres and* Laboratories

None of the physician-managed consulting rooms or surgical theatres at Korle Bu Teaching Hospital is known to have been accredited by regionally or internationally acclaimed organizations like the JCI, COHSASA or broadly ISO
Yet, the Central laboratory manned by Medical Laboratory Scientists has ISO accreditation.

The prescription forms are endorsed by physicians, surgeries done by surgeons, yet still none of the consulting rooms and surgical theatres in KBTH and other public hospitals is known to have obtained any international accreditation.
Medical Laboratory Scientists hold the view that the presence of Physicians in an area of work is not a guarantee for quality. If it were so, most of the consulting rooms, wards and theatres of hospitals would have been accredited by renowned global bodies.

Nonetheless, the services and daily sacrifice provided by physicians and Surgeons are well appreciated and held in high esteem by Medical Laboratory Scientists and Ghanaians in general. The outstanding accomplishment of individual practitioners in Medicine / Surgery is also duly recognised.

The attainment of ISO accreditation by Medical Laboratories such as Eastern regional hospital laboratory, Greater Accra regional hospital, 37 Military Hospital Laboratory, Public Health Reference Laboratory and Central laboratory of KBTH shows that, if Medical Laboratory Scientists have had a council and been represented by directors at the management of public hospitals, the transformation and impact would have been greater.

The workforce of health facilities and units with ISO accreditation are predominantly Medical Laboratory Scientists.

Recommendation

Bundling Medical Laboratory Scientists together with Laboratory physicians and subjecting both to the direct leadership of a Laboratory Scientist or Physician is unacceptable to both parties.

The following governance approach will ensure fairness for both parties:

1. A separate clinical unit should be created for Laboratory Physicians with their own head of department. This head of department will report to the director of Medical Affairs.

2. A head of Laboratory who is a Medical Laboratory Scientist should be appointed for the existing Laboratories including the central laboratory. This head of Unit will report to the Medical Laboratory Science Director or Director of Allied Health. The reason for making a scientist head the existing Laboratories is that over 90 to 95% of laboratory tests are directly within the domain of Medical Laboratory Scientists.
The other areas like anatomic pathology Morphology are already headed by Laboratory Physicians (Pathologist).

3. Clinical-Science coordinating unit comprising Physicians and Scientist should be created to liase the laboratories with clinical units. Their mandate will not be pursuing matters like co-signing Laboratory reports but rather weightier matters like ensure that interventional approaches like advanced stem cell transplantion and gene-editing techniques (CRISPR) for treatment of cancers and other genetic and chronic diseases are available in respective public hospitals in the shortest possible time.

Also, coordinating of translational research which requires collaboration between physicians and Scientists will be part of their mandate.
Leadership of this unit will be appointed by an independent body based on merit but not profession type. The composition of appointing body will be structured in a manner to prevent bias.

A timely resolution of the conflict between Medical Laboratory Scientists and Laboratory Physicians by fair and lawful means is needed to ensure harmony in the health sector of Ghana.

Author
Victor Obeng Ofori
Chairman, Medical Laboratory Professional Workers’ Union- Komfo Anokye Teaching Hospital Chapter.