PLUGS Podcast

Drs. Geoff Baird and Mike Astion discuss the current promises and pitfalls  of MCED testing in the USA including issues of cancer detection, overdiagnosis, costs, and insurance payments. 

Learning Objectives: 

After listening to the podcast the listener will be able to:

• Describe the societal tradeoff in implementing wide scale population cancer screening for 50 cancers
• List two downstream costs if the MCED screening test is positive
• Explain the implications and requirements of the Nancy Gardner Sewell Law regarding payment for cancer screening by the government and insurance companies.
• Describe the opposing points of view regarding the results of the  National Health Service clinical trial in the United Kingdom. 

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

MTS Website
https://medtraining.org/

Summary.
This episode of the PLUGS podcast was recorded live at ADLM 2026. PLUGS
members came to the PLUGS tradeshow booth to post questions on our question
board and participate in live Q&A. The answers were provided by University of Washington faculty as well as PLUGS members. Popular topics were covered, and there were fun interactions. Relax and have a listen.

Episode Index

2:00 - CBCs: Asking for too many Pathologist reviews
5:00 - Too much serum folate testing
7:00 - Improved naming of tests: Improvement with surprises
13:00 - Lipase, Amylase, Isoamylase
15:00 - Sendouts: From zero stewardship to effective stewardship
19:00 - Pathologists who do not love stewardship
23:00 - Gaining early wins in a newer stewardship program
26:00 - Erythrocyte Sedimentation Rate: use and misuse
33:00 - Yelling and screaming in conflict management
35:00 - Disruptive behavior
36:30 - When unusual tests are demanded by patients

Learning Objectives:
1. List two projects which are likely to be successful in early stewardship efforts List 3 common tasks in laboratory stewardship that can be performed with AI.
2. Describe two ways to achieve stewardship objectives even if pathologists are not enthusiastic about stewardship.
3. Describe a successful approach to addressing the problem of boutique labs that
solicit physician business directly rather than through your stewardship program
4. Compare and contrast “yelling and screaming” with more appropriate methods of conflict management in lab stewardship.

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

MTS Website
https://medtraining.org/

Summary.
In this episode of the PLUGS podcast, Mike Astion interviews Dr. Geoff Baird about AI in the Lab. Over the last year, Geoff and a few other University of Washington faculty members have been intensely studying and implementing AI in daily work. Geoff is on a quest to integrate AI into the UW Dept of Laboratory and Pathology. In this podcast, we discuss key aspects of this work. We first focus on some practical uses of AI that will resonate with PLUGS members. Then, Geoff ventures into applications that can significantly change the way we work.

For more information on PLUGS: https://www.schplugs.org
For more information on Medical Training Solutions: https://www.medtraining.org/

Learning Objectives:

1. List three common tasks in laboratory stewardship that can be performed with AI.

2. Compare and contrast basic AI that uses prompts to help with repetitive tasks and agentic AI, which can do complex tasks.

3. Name a barrier to the implementation of AI in the clinical lab.

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

MTS Website
https://medtraining.org/

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:

1. List two or three common conflicts in laboratory stewardship.
2. Describe the components of a structured apology, emphasizing the main needs of patients.
3. Name three common conflict management tactics and apply them to a case
   regarding 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 Website
https://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 Website
https://medtraining.org/

In this holiday edition of the PLUGS podcast, Drs. Jane Dickerson, Mike Astion and
Geoff Baird reflect on the history and learnings from PLUGS, as well as from the
stewardship 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 laboratory
stewardship, using celiac testing as an example.

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

MTS Website
https://medtraining.org/

In this episode of the PLUGS podcast, Drs. Mike Astion and Geoff Baird
discuss 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 beyond

33:00 PFAS: and the new war on Teflon

44:00 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 panels
• associated 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 who
• are on the quest for purity?

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

MTS Website
https://medtraining.org/

In this episode of the PLUGS podcast, Drs. Mike Astion and Geoff Baird
discuss some foundational principles in lab stewardship and management. Give a listen.

05:30 Dunning-Kruger effect: dealing with incompetence through feedback from
annoying logical contrarians.
09:15: The impostor syndrome: Helping lab workers who are experts but afraid to speak
up.
14:30: Lampshades: Would Mike wear one? A discussion of the normalization of
deviance 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 need
workplace rules to block the normalization of deviance.
23:50. Geoff thinks Baye’s theorem should be taught in kindergarten, when kids are
learning 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 a
large 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 cancer
screening challenges
32:00 Lab as a significant driver of unnecessary healthcare costs: excessive inpatient
testing and the need for stewardship.
40:00 Hey, that’s a lot of calcium testing and a whole heap of unnecessary calcium
infusions!
42:00 Alternative revenue sources for clinical labs: Is there revenue beyond clinical
testing?
47:30 Are government dollars clean? And industry dollars dirty?

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

MTS Website
https://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 Website
https://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 Website
https://medtraining.org/