Jul 21, 2016, 08:37 AM by KirstiAnn Clifford, UTMB Impact
Michael Laposata, MD, PhD, vividly remembers an exchange he had with an internal medicine resident back in 1984.
"I was a first-year clinical pathology resident at the time and he
asked me a simple lab test question; he didn't know how to further
evaluate an abnormally prolonged clotting test for a patient with
unexplained bleeding," said Laposata, professor and chair of UTMB's
Department of Pathology. "It surprised me."
Laposata realized then that he had knowledge about making a
diagnosis that the internal medicine resident - and most residents in
other specialties - didn't have. If the two hadn't talked, the resident
said he would have "guessed" which tests to pick and what the results
Since that conversation more than 30 years ago, Laposata has made
it his mission to eliminate guesswork by creating diagnostic medical
teams, or DMTs. The teams are designed to offer healthcare professionals
assistance in selecting appropriate diagnostic tests and interpreting
results for individual patients. It's a collaborative approach, with
pathologists,clinical laboratory scientists, expert physicians and
others all sitting at the table.
"The bottom line is that if you or a loved one is seriously ill
with an unknown diagnosis, you want an expert in the field with current
knowledge directing your diagnostic evaluation in real-time and
explaining it all to you," said Laposata. "DMTs effectively bring
pathologists and lab scientists to the bedside, helping physicians order
the correct test for the right patient at the right time, and then
using the test results to select the most appropriate treatment."
Before joining UTMB nearly three years ago, Laposata spearheaded
DMTs at several institutions, including Vanderbilt University, where
DMTs were formed for coagulation disorders, blood cancers, infectious
diseases, endocrine-related hypertension, transfusion medicine and more.
The teams were a success - with data showing improved patient outcomes,
shorter hospital stays and reduced health care costs.
Now, Laposata is bringing his passion for diagnostic teamwork to
UTMB. He formed a coagulation DMT a year ago, which meets every
afternoon to go over complex patient cases. Dr. Jack Alperin, a
hematologist and associate director of the UTMB Blood Bank, Dr.
Aristides Koutrouvelis, a critical care anesthesiologist, Dr. Chad Botz,
director of the Special Coagulation Laboratory, several pathology
residents and visiting physicians join Laposata in a conference room in
the Clinical Services Wing, where they pull up patient records and
provide diagnostic conclusions and information to physicians needing
With clinical lab testing options continuing to grow and becoming
more complex, Koutrouvelis said, "it's not always clear what the best test
is for a patient."
"It's almost impossible for clinicians to practice the most
advanced medicine without a team like this that stays on the cutting
edge," he said.
For example, there are at least a dozen tests with the word
"Vitamin D" in the title presented to physicians who simply want to know
if their patient is Vitamin D deficient. So which test is the best
test? Koutrouvelis said the DMT proves its worth in those instances.
"It allows for a number of people to give their different
perspectives so we can optimize patient care and do so in a
collaborative way," he said. "I've seen situations where there has been a
cost savings because the proper labs were done and the proper meds were
given. There's a patient safety impact, as well. I've had several
patients with a coagulation abnormality that we were able to give a
life-saving product because we worked together to come up with the best
Laposata said feedback from physicians has been positive so far. In
the future, he hopes to create a UT System-wide group of experts in all
major areas of clinical and anatomic pathology and have DMTs for dozens
of clinical areas to bring diagnostic experts electronically to the
bedsides of all patients in Texas. It's a big task, but Laposata said
he's up to it.
"With an estimated 64,000 people in the U.S. dying from diagnostic
errors every year, something has to be done. I haven't lost my
enthusiasm. It may take a while to effect major change, but I'm going to
work on this until I can't do it anymore."