Ponder over this...

When a 47-year-old woman from Jaipur got back results of her breast biopsy from her neighbourhood Pathology Laboratory recently, she was faced with a few medical options. The lab had reported invasive cancer hence requiring immediate surgery. She underwent a mastectomy, followed by two months of painful radiation treatments, unaware that there had been a mistake. When the tissue was sent for histopathology it revealed no evidence of the tumour at all. When the patient's family started raising queries it turned out that the lab had mistakenly switched biopsy specimens. She had no cancer. The positive reading actually belonged to another 64-year-old lady from Delhi.

In recent years, allegations of serious laboratory errors have continued to mount. Lawsuits and complaints citing faulty lab operations are accumulating nationwide, naming some of the country's top medical centers.

With thousands of pathology labs to choose from, ease of location still continues to be a strong factor in the choice of a lab and patients may therefore knowingly or unknowingly choose an inappropriate lab.

We as customers need to be aware of our rights and as such therefore need to be aware about the basic credentials that any testing laboratory should have. After all we are placing our life in their hands.

While choosing a pathology laboratory we need to be careful in ensuring that the following criteria are met with.

1. Accreditation: Accreditations imply that the laboratory has been certified by an independent authority to be conducting the prescribed laboratory tests under a set of rules and regulations laid down by the government as well as other agencies having a focus on quality control. NABL (National Accreditation Board for Testing & Calibration Laboratories) and CAP (The College of American Pathologists), USA are the predominant bodies that currently certify good laboratories in India. Accreditations therefore form the foundation for any good lab putting it at par with any international laboratory.

An accredited laboratory would generally have a certificate stating the same at its reception area. " Most of the pathology laboratories that are run in the country do not follow any quality benchmarks as there are no stringent requirements. Any body can open up a lab in the country if he so desires. This sensitive service can, at most be governed by Shops and Establishment Act only. We were the first ones in the country to get ourselves accredited from NABL and CAP, USA because we felt we owed it to our patients to serve them quality pathology solutions." said Dr Sanjeev K Chaudhry, CEO of SRL Ranbaxy, India's largest pathology laboratory network.

2. Qualified Pathologist: A good laboratory should have its own dedicated full time reporting doctor. We all are familiar with the term -Pathologist. Pathologist is a qualified specialist in field of laboratory medicine who ensures accurate investigation and interpretation of the result. Any lab that you are visiting must have a qualified full-time pathologist. It is also always of immense advantage if a pathologist or a doctor is available when a patient arrives to collect his report so that any queries can be addressed immediately.

3. Qualified Phlebotomists (trained sample collectors)/Technicians- Phlebotomists, who are qualified and trained to draw and collect the sample of the patient are the human face of the laboratory. They should be trained professionals, who follow best practices to ensure the safety of patients. Seemingly mundane but precautions like wearing gloves should be followed. "In fact as a customer, you should insist upon their wearing the gloves when they are to draw out the blood sample. Not only is it important for their safety, but more importantly, yours too!!" emphasises Dr Chaudhry. A phlebotomist should have either a Diploma in Medical Lab Technology or at least many years of experience in phlebotomy.

4. Vacutainer System for Sample collection: In most laboratories around, it is a normal practice to use a syringe to draw out the blood sample and then the same is transferred to another container for test purposes. This method, normally employed to cut costs is an undesirable practice as it is fraught with the risks of sample getting contaminated and could seriously affect the accuracy of results. "All good laboratories conduct phlebotomy by the vaccutainer system as the use of the same eliminates completely the risk of Pre Analytical errors. In the vaccutainer system, the sample is straight away drawn into a predesigned sterilized sample container and sent forward for testing. In fact SRL Ranbaxy was the pioneer in the country in introducing vaccutainer collection system when we started operations in India, 9 years ago" added Dr Chaudhry.

5. Test Range and Menus- A good accredited lab is designed to benefit the patients. The laboratory should therefore be independent and offer its own comprehensive test menu essentially being tested by its own in-house facility. They should be able to carry out even the most complex of the tests at their own facility and should be able to develop newer tests in order to support doctors for accurate diagnosis. "Only SRL Ranbaxy has its own dedicated R& D set-up that is constantly engaged to expand its test range. Already we carry out over 3000 tests spread across over 95 technologies- which is the largest test rang menu in the country." added Dr Sanjeev K.Chaudhry.

6. Good Ambience, Courtesy & Hygienic conditions inside the laboratory: - A good Lab must be clean, well lit so as to ensure the patients comfort level. Efficiency at the reception and front office is another aspect to be considered as a good Lab attribute. Staff at the laboratory should be courteous, well qualified and able to answer the patient's queries. The environment at the laboratory should be such that it offers a pleasant patient experience. The laboratory including its toilets should be impeccably clean.

7. Patient / Data Integrity and Secrecy- A good lab will always respect each patients individuality. Phlebotomy should be done with at least some amount of privacy. The responsibility also involves ensuring the accurate accession i.e. receipt, recording, grouping and labeling of specimens and the communication of tests results.

A good lab will always maintain secrecy and integrity of the patient's report(s). Special care should be taken for the HIV test reports to be dealt with as per recommended guidelines of NACO (National Aids Control Organization).

8. Report Delivery: Report delivery must always be at the promised time and should therefore not be associated with any undue waiting period. Pre intimation to the patient or his family is mandatory in cases where the laboratory is anticipating a delay in reporting due to any reason. Reports must be accurate and reproducible." Minimising the anxiety time of our patients is what drives SRL Ranbaxy.