PLUGS Podcast

In this 11th edition of the PLUGS podcast, Drs. Jane Dickerson, Mike Astion and Geoff Baird work through cases of conflict management and apology related to laboratory stewardship. The cases come from PLUGS members and add depth to our recent PLUGS National Webinar on the same topic. The cases cover disruptive physicians, structured apologies, overly large test panels, special test requests, point-of-care testing, screaming in the car, and much more. Have a listen.Learning Objectives:List two or three common conflicts in laboratory stewardship.Describe the components of a structured apology, emphasizing the main needs of patients.Name three common conflict management tactics and apply them to a caseregarding a disruptive physician, or a case of a physician who wants to order a test that is not on the test menu.PLUGS Website: https://www.schplugs.org/MTS Websitehttps://medtraining.org/

In this 10th edition of the PLUGS podcast Dr. Mike Astion interviews Paige Haas and Darci Sternen, who are Laboratory Genetic Counselors in the Dept of Laboratories at Seattle Childrens Hospital. Paige and Darci are active in our clinical laboratory practice and in our PLUGS program where they are involved in helping clients, providing education, and in policy making. The conversation with Darci and Paige covers a number of topics including differentiating the role of Lab genetic counselors from clinic-based genetic counselors. In addition, we discuss applying lab stewardship strategies to reduce low-value testing, as well as to obtain optimal genetic testing while reducing denials for that testing.PLUGS Website: https://www.schplugs.org/MTS Websitehttps://medtraining.org/

In this holiday edition of the PLUGS podcast, Drs. Jane Dickerson, Mike Astion andGeoff Baird reflect on the history and learnings from PLUGS, as well as from thestewardship practices at the University of Washington, Seattle Childrens and PLUGS members around the country. We also give PLUGS its first official mascot, and draw analogies between PLUGS, TV Shows and Sports. Enjoy and thanks for being part of the story.Learning Objectives:1. Identify key strategies for building interdisciplinary relationships to support laboratory stewardship programs within health systems.2. Explain how clinical decision support (CDS) systems can improve lab test ordering, naming one challenge in implementing them, and describing one potential future improvement in CDS that involves AI.3. Name two accomplishments of PLUGS that have had a national impact.4. Define why it is important to have specific CPT coding to support laboratorystewardship, using celiac testing as an example.PLUGS Website: https://www.schplugs.org/MTS Websitehttps://medtraining.org/

In this episode of the PLUGS podcast, Drs. Mike Astion and Geoff Bairddiscuss the massive testing panels associated with the belief that the environment–through its many metals, biotoxins, microbes, and allergens—is a significant source of unresolved signs and symptoms. The time stamped highlights are listed below.00: 00 Defining the quest for purity.07:00 Are the providers true believers, or is this quackery?14:00 Are the patients psychiatric or is this simply dissatisfaction with conventional care?20:00 War on Aging: Are we in bondage to decay and death?25:40 Heavy Metals: Germanium, Palladium, Thorium and beyond33:00 PFAS: and the new war on Teflon44:00 Consequences of the quest ---for patients, labs, and insurers--and how to mitigate them.1:01:00 How can we help conventional providers cope with these orders and results?1:06:00 Stories from the Quest: A person discovers double-blind testing, and a person turns blue.Learning Objectives:Define the quest for purity and the types of testing associated with it.Describe the role of belief, experience and evidence in the large test panelsassociated with the quest for purity?Describe two negative consequences of the quest for purity and how a risk-based approach can mitigate these consequences?Explain one way clinical labs can help conventional providers with patients whoare on the quest for purity?PLUGS Website: https://www.schplugs.org/MTS Websitehttps://medtraining.org/

In this episode of the PLUGS podcast, Drs. Mike Astion and Geoff Bairddiscuss some foundational principles in lab stewardship and management. Give a listen.05:30 Dunning-Kruger effect: dealing with incompetence through feedback fromannoying logical contrarians.09:15: The impostor syndrome: Helping lab workers who are experts but afraid to speakup.14:30: Lampshades: Would Mike wear one? A discussion of the normalization ofdeviance and how it impacts the workplace.18:15 Slowly drifting into deviance.20: 00. Is Mike’s use of swear words deviant? Could feedback help?21:30. Regular football rules vs “Kill the guy with the ball”: How to explain why we needworkplace rules to block the normalization of deviance.23:50. Geoff thinks Baye’s theorem should be taught in kindergarten, when kids arelearning how to count.25:00 In screening, finding true positives amongst the false positives is a complex,anxiety-provoking, and expensive proposition.28:00 Geoff has a false positive adventure: Even a public health success produces alarge number of anxiety-provoking false positives.29:30. “I don’t have cancer!” Why aren’t patients angrier about false positives?31:00 “I don’t have cancer!” Mike’s false cancer diagnosis as an example of cancerscreening challenges32:00 Lab as a significant driver of unnecessary healthcare costs: excessive inpatienttesting and the need for stewardship.40:00 Hey, that’s a lot of calcium testing and a whole heap of unnecessary calciuminfusions!42:00 Alternative revenue sources for clinical labs: Is there revenue beyond clinicaltesting?47:30 Are government dollars clean? And industry dollars dirty?PLUGS Website: https://www.schplugs.org/MTS Websitehttps://medtraining.org/

In this episode, Dr. Geoff Baird and I interview Elizabeth Pendo, the Senior Associate Dean of Academic Affairs, and the Kell-eye Y Testy Professor of Law at the University of Washington School of Law. Our topic is medical legal collaboration to improve laboratory stewardship. Dean Pendo has a broad experience in health care law that includes years of legal practice in the private and public sector, as well as a noteworthy academic career. Her legal work, teaching, and academic publications encompass perspectives of patients, providers, insurers, and government. In the podcast we cover a broad range of topics including: Federal vs. state rules governing health insurance; the role of the Affordable Care Act in supplementing earlier federal legal frameworks; The standard of care from a legal perspective; Current challenges regarding incorporating the standard of care into medical necessity determinations by private, and public, payers; Perspectives of patients, labs, and insurers as regards insurance denials.PLUGS Website: https://www.schplugs.org/MTS Websitehttps://medtraining.org/

This version of the podcast was recorded live at the PLUGS Summit in Seattle Washington on April 4, 2025.  As part of the Summit, we invited attendees to a PLUGS podcast recording on the second day of the Summit.  The goal was to discuss issues raised at the Summit and answer questions from attendees. Our discussion covered a range of topics including fraud and other causes of egregious overutilization; maintaining the lab’s agency within a healthcare system; the good and evil of free testing; reference lab relationships; and hard and soft ways of enforcing stewardship policies.  I was helped, as usual, by my colleague and stewardship expert, Dr. Geoff Baird, Chair of the University of Washington Department of Laboratory Medicine and Pathology.   PLUGS Website: https://www.schplugs.org/MTS Websitehttps://medtraining.org/

In this episode of the PLUGS Podcast, Dr. Mike Astion and Dr. Geoff Baird interview Dr. Brody Foy, a mathematician and computer scientist who researches practical improvements in interpreting clinical lab data. Dr. Foy discusses the practical use of personal reference ranges, the potential overemphasis on omics vs common testing, why Mike should not hate the future, AI in lab medicine, AI safety, theproblem of statistical illiteracy in test interpretation, and, of course, how “my mother medicine” applies to AI to keep moms safe. Overall, the episode provides valuable insights into the intersection of reference ranges, AI, and statistics in lab medicine.For more information on Dr. Foy's work on personal reference ranges see:  Foy BH, et al. Haematological setpoints are a stable and patient-specific deep phenotype. Nature. 2025 Jan;637(8045):430-438. doi: 10.1038/s41586-024-08264-5. Epub 2024 Dec 11. PMID: 39663453.PLUGS Website: https://www.schplugs.org/MTS Websitehttps://medtraining.org/

Using every academic trick in the book, including the invocation of “my mother medicine” and an analogy to flying cars, Drs. Mike Astion and Geoff Baird interview Bridget Wegner, Director of Partnerships at Clarivate about the commercialization of lab data.  Bridget, a seasoned lab and IT professional, emphasizes the importance of lab data in advancing drug development and making drugs more available to patients with rare diseases. The conversation covers the benefits, and risks of selling lab data; privacy and security concerns; and the practicalities of engaging with Clarivate. Follow this link for Clarivate Real-World Data Offeringshttps://clarivate.com/life-sciences-healthcare/real-world-data/#offerings(choose Real-World Data Rare Disease Franchise to contact an expert)PLUGS Website: https://www.schplugs.org/MTS Websitehttps://medtraining.org/

Summary:In this episode of the Plugs podcast, Dr. Mike Astion interviews Dr. Allison Chambliss, Director of Laboratory Stewardship at UCLA Health, which recently won PLUGS Member of the Year. Dr. Chambliss discusses her role in enhancing laboratory stewardship including optimizing reference lab testing, distinguishing experimental testing from medically necessary testing, reducing duplicate orders,adjusting electronic ordering to ensure better test selection, and more. She discusses the importance of personal communication with clinical colleagues inside and outside her Department of Pathology and Laboratory Medicine, and how to improve the interaction between the lab stewardship committee andhospital leadership. Dr. Chambliss also shares insights into why Clinical Chemists make excellent Lab Stewards and reflects on the challenges and successes of implementing stewardship initiatives at UCLA.Links to stewardship work by Dr. Chambliss:How a Program Manager Aligns Quality Improvement, Laboratory Stewardship, and Equity, Diversity, and Inclusion in Pathology and Laboratory Medicine:https://www.myadlm.org/cln/articles/2024/julyaugust/how-a-program-manager-aligns-quality-improvement-lab-stewardship-and-deiImplementation of an automated EMR workflow to facilitate genetic consultation and review of inpatient genetic test requests:https://www.myadlm.org/cln/articles/2024/septemberoctober/implementation-of-an-automated-emr-workflowPLUGS (Patient-Centered Laboratory Utilization Guidance Service):PLUGS Summit:  https://www.schplugs.org/plugs-summit/    April 2-4, 2025, Bell Harbor Conference Center Seattle, WAPLUGS Website: https://www.schplugs.org/MTS Websitehttps://medtraining.org/

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 Websitehttps://medtraining.org/