Ask The Expert

Edition: May 2005 - Vol 13 Number 05
Article#: 2107
Author: Repertoire

Q. A CLIA inspector told one of my accounts that she could do less QC on her test kits and instruments. My account would love to save the time and money but isn’t exactly sure how. I’m not at the head of the class when it comes to CLIA and would like a short but sweet explanation of this to share with my accounts.

A. What you’re referring to is called equivalent quality control, or EQC. The final CLIA regulation made EQC an option for all POLs, but most don’t know about it. Up until now, labs had to run at least two QC samples per day. The final CLIA regulation lets them reduce this frequency to once a month or once a week, if they use a test with built-in monitoring systems. Table 1 explains exactly what the three EQC options entail. The test manufacturer can tell you what category (see Type of Test column in Table 1) its test fits into. You can find more information about this at

Q. How do I politely tell a doctor he should be screening for a common chronic disease when he’s not?

A. Doctors do data. Every red-blooded, card-carrying physician depends on data (peer-reviewed studies) to determine how he practices medicine. With that said, another adage comes to mind: You can lead a horse to water, but you can’t make him drink. So you need to take a two-pronged approach to convince your accounts to do the right thing.

Let’s start with a good example of recently published data that said, “Office Spirometry Improves Early Diagnosis of COPD” (Chest, April 19, 2004). This landmark study gives evidence that primary care doctors should screen patients for chronic obstructive pulmonary disease (COPD).

Following are some sound bites from the study:

• Without the use of spirometry by primary care physicians, nearly half of patients with COPD will remain undiagnosed.

• Office spirometry nearly doubled the number of known cases of COPD, which reinforces the need for spirometry testing in general physician practice.

• COPD is the fourth-leading cause of death in the United States and is widely under-diagnosed in the primary care setting.

• Primary care physicians play a key role in the detection of COPD and should be encouraged to learn the technique of spirometry and incorporate the screening method into regular practice.

Manufacturers of the equipment you sell should provide you with these proof sources that justify using their products. Once you have the data, all you have to do is get it into the hands of the decision maker, and then keep quiet. Let the data do the talking.

You’ve led the horse to water, but can you now make him drink? It might depend on his age. Studies show that you’ll have a much harder time with older physicians. A recent provocative study from Harvard Medical School shows that older doctors are less likely to adhere to guidelines for cancer screening, to use proper medications to treat heart attacks or to adopt other evidence-based treatments for everything from surgery to treating childhood fevers. The study also found that heart attack patients were 10 percent more likely to die in the care of a doctor 20 years out of medical school compared with a recent graduate. Before we trigger a generational battle, the best doctors ideally would be the ones who both have the experience and make a commitment to keep up with guidelines. But older doctors report they find it hard to keep up with new medical knowledge, especially since they’re pressed for time to see all their patients. Older doctors are also slower to adopt new approaches, because they were trained to rely heavily on their own experiences. By contrast, younger doctors were trained to depend on research published in medical journals to continually update the way they practice medicine.

In our Ask the Expert column, Dr. Sheila Dunn dishes out clear, concise and, sometimes, hilarious answers to those pesky customer questions that keep sales reps awake at night. Just think: The next time a customer asks you something like, "Who says we have to fix that gaping hole in our exam table?" or "How come we get reimbursed less for that test than we pay for it?" you can come back with a witty repartee to put the lid on those concerns.

So, come on… Ask the Expert. Email your questions to