The Clinical Laboratory Profession,Threats, Concerns & Remedial Strategy - 2008-10-27 Document prepared by Dr. Adel Mastori, adopted by the executive committee of the Syndicate and presented to the WHO Beirut Office The Clinical Laboratory Profession Threats, Concerns & Remedial Strategy Introduction: For almost 3 decades, no or little work that targets to “modernize” the practice of the Clinical Laboratory Profession was achieved; the last legislation dealing with the profession dated as early as 1982. Besides, the situation of the country, from that time and to date, was the appropriate ambiance for the development of an accentuated corruptive environment that affected almost all professional fields. Above all, this has resulted in a sharp decline of the standard of services, and as far as Medical Health Care System is concerned, unethical practices were and still are, largely contributing to the amplification of the Health Care bill. In this attempt to deal with this major issue, this review will first elaborate on the current situation of the profession, the contributing factors, the consequences, and finally undertake to define medium to long-term measures that may trigger a remedial process. The current dilemma of the Profession: Abuse in prescribing medically unjustified diagnostic procedures in general and laboratory investigations in particular, has become a key trait of Medical practice. That was mainly the direct outcome of illegal and illegitimate “partnership” between some Clinical Laboratories and some prescribing Physicians. The challenges: Like other Medical specialties and many other professions, ethics and competition dictate to a certain extent the profile of the practical practice of a professional. In the case of our profession, illegal practices (mentioned above) at some Clinical Laboratories and illegal competition (exercised by legal & illegal centers) represent items of a negative vicious circle that makes it difficult to define the triggering point. The illegal competition may be attributed to the following: a- Dispensaries and primary Health Care Centers: a decree was issued in 1992 to regulate Laboratory work in dispensaries; it necessitated the presence of, at least, one qualified technician among the staff and only 7 specified routine tests were allowed to be performed at the premises, free of charge. That decree, irrespective of its many pitfalls, is currently extensively violated; all kinds of Laboratory tests are being performed in many dispensaries by unqualified personnel, without, quite often, any basic and essential professional control. b- Illegal practices at many Pharmacies: where many “rapid” tests are performed and with the advent of dry chemistry, the list of such tests tends to get longer. Besides the fact that such practices are illegal, the technology used in Pharmacy testing totally lacks the component of quality assurance that represents the essence of Clinical Laboratory work. c- Illegal specimen collection centers: widely exercised in pharmacies, clinics and illegitimate specimen collection places; this critical part of the Laboratory manipulation (pre-testing phase) is being practiced in such places without any respect to the fundamental requirements for a proper practice. d- Unethical practices at legitimate Laboratories: very unfortunately, many colleagues are breaking code of professional ethics and rules and regulations that regulate our profession. The impact The direct consequences of the resulting chaotic situation are reflecting on both sides of the equation: the public and the “ethical” professionals. a- It is evident that Laboratory testing in many primary health care centers being unsupervised makes the quality and reliability of such services highly questionable. The same applies to legitimate Laboratories where illegal practices are being exercised. b- Because of the above mentioned abuse, Insurance funds, public and private, are relatively imposing reduced unfair fees for Laboratory services; it is worth to remind that the NSSF laboratory fees, being the reference scale for pricing of such services, was never subject to any amendment since 1988. So most obviously, “ethical” professionals are economically suffering from this situation. The vision for a remedial process : With the lack of any measure to address the current problematic situation, the problem, regarding Clinical laboratory practice, is getting more accentuated and is contributing to the jeopardy of the whole Medical care system. Appropriate curative approach necessarily necessitates the involvement of all parties concerned namely the Ministry of Public Health, “Ordre(s) des Médecins”, “Ordre des Pharmaciens”, National Social Security Fund (NSSF), “Syndicat des Hopitaux”, private Insurance Companies, supportive organisms (e.g WHO) and “Le Syndicat des Biologistes du Liban”. Subsequent to a comprehensive review of the problem, a committee assembling the above mentioned parties would design a curative strategy and set a group action plan. Such a project should tackle the following items: a- Screening of primary Health care centers in the country and analysis of data concerning their respective services. b- Review of legislations that regulate the profession; and addressing the difficulties concerning the implementation of respective regulations. c- Updating current legislation and introducing new bylaws that may deal with emerging situations. d- Review licensing requirements for Primary Health Care centers and introducing necessary amendments that may assure the quality of the center services. e- Reinforcing the cooperation and interaction of the parties involved in this process. f- Considering the procedural mechanism to make Clinical laboratory External Quality Control and implementation of Clinical Laboratory Accreditation Standards, both compulsory exercises. Conclusion Many communities in the different regions of the country are being deprived from appropriate Clinical Laboratory services; our profession routing down the hill has become the trend. This review is promoting the necessity of a team work in the endeavor to deal with a major health threat. Back