A Book Report: QA and the Pathology Laboratory

Professional reading literature falls into a interesting range these days. At one end of the spectrum is the ethereal, electronic opinions in the form of web-journals. Of more substance, but just as fleeting are electronic rapid access peer-reviewed journals - articles of substance with extremely short shelf-live. Next along is our traditional journal manuscript in printed form. Articles usually of substance accepting that their value is generally transient. Journal articles reference impact is short, especially when compared to the longevity of the paper upon which they are written. And at the other end is the textbook; a reference usually that is out of date before it was published, but which usually contains principles of a more general nature that provide a structure to learning.
Somewhere within that spectrum lies the books published by CRC Press. These look like text books and generally have chapters with a reference structure, but they tend to be very current with some intermediate live value. Quality Assurance in the Pathology Laboratory: Forensic, Technical, and Ethical Aspects, edited by MJ Bogusz and published by CRC Press (2011) falls into the category.
This an intermediate sized book (374 pages) in 10 chapters, that gives fairly broad coverage to the subject. There are chapters for the pathologist, the chemist, the qualitologist, the educator, the standards development folks and the assessment bodies. There is material on pre-examination, examination, interpretation, and post-examination phases. There is a lot on laboratory process and some on point-of care.
You might think that a fairly short book with so broad a mandate would have more misses than hits. But you would be wrong. The success is in the selection of authors, a mix of Americans and Europeans, all expert in the field.
From my personal perspective, I found the chapter on Education and Training in the Changing Environment of Pathology and Laboratory Medicine by Gian Cesare Guidi and Giuseppe Lippi as the most enlightening. I thought that it was going to be about programs for training pathologists about quality assurance, knowing that would be a very short chapter because it would be comprised of one sentence: “There is insufficient evidence of any substantial training in quality and its techniques for pathology residents.” The end.
Instead, the authors did a very credible survey of international curricula in training at the undergraduate level, the professional school level, and the postgraduate level, for both medical and technologist graduates, and makes the argument that there is room for new and complex changes in core curriculum for laboratory professionals. It is an excellent read for anyone engaged in training and education.
The weakest chapter, but still useful was on Quality Assurance of Quantification using Chromatographic Methods with Linear Relation between Dose and Detector Response by Georg Schmitt and Rolf Aderjan. Actually (and fortunately) the chapter had virtually no relationship to the title; rather it provided a survey of quantification tools such as calibration, precision, bias, and of course MU.
Whether the authors intended it or not, they made one of the most important and telling sentences in the whole book. “Measurement uncertainty is an important part of the reported result. According to ISO 17025, the MU must be reported.” I can’t thing of anything more telling about MU. Its only purpose in the medical laboratory is to satisfy the statistical whims of some accreditors. (I feel a rant coming on; more on this later).

Let me be clear. I don’t know any of the authors personally. I don’t know the editor and I have no financial links direct or indirect to CRC Press. (I co-edited a book on STDs with them in 1997 and co-wrote a chapter on Yersiniosis in 1988). But I would recommend this book to all laboratorians. It provides an excellent survey of quality assurance information, and good insights, and will be a useful reference for at least the next 5 years. 

PS:
For those of you still thinking about our Quality Weekend Workshop, time is getting short.  June 17 is just around the corner.  Register NOW!!
www.POLQMWeekendWorkshop.ca