Terrible People or Terrible Choices? Characteristics of Bad Ideas in Lab Stewardship and How to Avoid Them

Dr. Mike Astion from Seattle Children's Hospital and the University of Washington (UW) hosts a podcast about the root causes of bad ideas in lab stewardship, featuring Dr. Geoffrey Baird, the Chair of the UW Department of Laboratory Medicine and Pathology. They discuss such root causes as the Halo effect and other forms of false expertise;  financial conflicts of interest; and "truthiness", which is the idea that something must be true because it sounds like it should be true, even when it is not true.  They discuss issues such as overly large test panels, free testing, misuse of point of care testing, and the desire of some  physicians to choose any reference lab or test without oversight. They highlight past problematic ideas like Theranos, emphasizing that revolutionary promises in lab testing often fail due to fundamental statistical, biological and technological limitations. They also address the challenges of competing with free testing offers and the importance of selecting appropriate specimen sources for reliable testing outcomes. In tackling bad ideas, they underscore the necessity of approaching disagreements with humility, balancing data presentations with practical concerns, and fostering collaborations that include staff who are logical contrarians --but  who are not huge, depressing downers--to achieve a balanced and effective stewardship approach.

PLUGS Website:
https://www.schplugs.org/

MTS Website
https://medtraining.org/

Chapters

• 0:10 Introduction to Bad Ideas in Lab Stewardship including root causes
• 2:43 Root Cause: Misunderstanding Bayes Theorem and The Effect of Low Pretest Probability
• 4:08 Root Cause: Financial Conflicts of Interest
• 5:28 Root Cause: The Dunning-Kruger Effect, the Halo Effect, False Expertise and Expertise Overconfidence
• 13:17 Managing the Tradeoff Between Sensitivity and Specificity in Cancer Screening
• 17:45 Theranos Case Study: Specimen Issues
• 18:41 Challenges of Fingerstick and Dried Blood Spot Testing
• 27:12 Alternative Specimen Types (Hair, Saliva, etc.)
• 34:55 The Complexity of Wearable Sensors and Future Limitations
• 36:23 Breath Covid Testing and Metabolomics
• 40:21 Point of Care Testing: Challenges, Overoptimism, Infectious Disease Risks
• 53:12 Specimen Handling and Pre-analytical Errors
• 59:05 The Problem of Free Testing and Its Complex Implications
• 1:02:14 Patient Financial Protection in Lab Testing
• 1:06:14 Overcoming Bad Ideas, and Implementing Best Practices including the Logical Contrarian
• 1:11:51 Compromises and Pilot Programs in Lab Testing