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?

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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:
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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:
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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, the
problem 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.

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https://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 Offerings
https://clarivate.com/life-sciences-healthcare/real-world-data/#offerings
(choose Real-World Data Rare Disease Franchise to contact an expert)

PLUGS Website:
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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 and
hospital 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-dei

Implementation 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-workflow

PLUGS (Patient-Centered Laboratory Utilization Guidance Service):
PLUGS Summit:  https://www.schplugs.org/plugs-summit/   
April 2-4, 2025, Bell Harbor Conference Center Seattle, WA

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https://www.schplugs.org/

MTS Website
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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 Website
https://medtraining.org/