Professional Autonomy in the Running of Diagnostic Laboratories in Nigeria

Professional autonomy is defined as the quality or state of being independent and self-directing, having authority to make decisions, enabling professionals to exercise judgment in accordance with one’s professional knowledge base and regulatory framework. The aim of this review is to highlight the importance of professional autonomy in the running of diagnostic laboratories in Nigeria. Professional autonomy is the professional duty of care and working within the legal, ethical and regulatory frameworks that govern a profession. Pathology is the study of diseases. It is the bridge between science and medicine. While the Medical Laboratory Scientist manages the science side of pathology, Pathologist manages the medicine or clinical part of the bridge. Medical Laboratory Scientists in Nigeria are regulated by the Medical Laboratory Science Council of Nigeria (MLSCN) while Pathologists are regulated by the Medical and Dental Council of Nigeria (MDCN). The role of the Medical Laboratory Scientist as a Laboratory Manager is huge and involves the management of staff regulated by the MLSCN (Medical Laboratory Scientists, Technicians and Assistants) including support staffs, equipment, reagents and consumables in the delivery of accurate, precise, reproducible and timely diagnostic results that enable clinicians to make an informed decision in the effective management of patients. They provides medical laboratory diagnostic products and services; evaluate laboratory information management system (LIMS); report results according to SOP and protocols; maintain medical laboratory equipment performance, service, repair, replace and troubleshoot; ensure staff training and compliance; carry out instrument validation and reagent certification; forecasting and budgeting; manage diagnostic laboratory revolving funds, inventory control management of equipment, reagents and consumables; maintain medical laboratory productivity by monitoring and scheduling workload and making operational or staffing adjustment; ensures that laboratory participates in external quality assurance and have a robust internal quality control program; perform laboratory staff proficiency testing; develop SOP, procedures and protocols; train employees; maintain security and confidentiality of patient data; carry out staff recruitment, orienting, training, appraisal, counseling, retention and discipline; ensures that laboratory staff maintain their professional license and are involved in continuous professional development; review professional publications; help in the induction and orientation of new staff, trainee physicians, nurses, students and visitors to the diagnostic laboratory; perform quality audits and provide administrative support and supervision of Medical Laboratory Scientist on call. Pathologists on the other hand run their specialty-based clinics; take consults from the clinical colleagues; perform clinical audits; act as clinical liaison in the interpretation of specialized laboratory test result to their clinical colleagues; offer specialty-based clinical advice to their colleagues; be on call to manage their patients on admission as well supervise their trainee pathologist on call; train their residents; carry out clinical research; manage their clinical budget and clinical-related revolving funds. It is the best practice that the scientific aspect of the bridge is managed and headed by a Medical Laboratory Scientist while the medicine aspect is headed and managed by the Pathologist. It is against the principle of professional autonomy, harmony and holistic care for diagnostic laboratories predominantly staffed by professionals regulated by the MLSCN (Medical Laboratory Scientist, Technicians and Technicians) to be headed by another professional who is regulated by a different regulatory agency and who is not privy of the MLSCN requirements and standards required for the training, management and practice of the profession of Medical Laboratory Science. The implementation of these best evidence-based practices is needed to allow for harmony in diagnostic laboratories in Nigeria and will facilitate the rendering of best and holistic medical care to well-meaning Nigerians.