Re-branding, re-imagining and re-defining ourselves

This idea originates, as far as I know, from Michael Sims, president and CEO of NspireHealth. I got it second hand and suspect that it is a small part of a larger presentation but this one point is worth discussing by itself. Specifically, we call the places we work “Pulmonary Function Laboratories” and this is at best an outdated and somewhat obscure term that doesn’t do much to make it clear what we do.

What’s wrong with calling it a Pulmonary Function Lab?

Well “Pulmonary” is okay since it’s a rather dignified and erudite term for the part of the body we’re primarily concerned with. “Function” however, is a somewhat vague or ambiguous term. The dictionary definition (or at least one of them since the other is mathematical) is “an activity or purpose natural to or intended for a person or thing”. That sort of applies to what we do but not with any particular precision or clarity.

I think that it’s the words “Lab” or “Laboratory” are the biggest problem since they conjure up images of Bunsen burners, test tubes and white-coated scientists engaged in research (the buzzing electrical arcs climbing up Jacobs’ Ladders and cries of “it’s alive!” are optional). The dictionary definition is “a room or building equipped for scientific experiments, research, or teaching, or for the manufacture of drugs or chemicals.” Not particularly specific to what we do and not necessarily a place you’d want to have any tests performed.

Michael Sim’s suggestion was that we re-brand our place of work by calling it “Pulmonary Diagnostic Services” instead. This is an unambiguous title that clearly identifies what we do. More than that, it gives us an opportunity to re-imagine and re-define exactly what it is we do.

So, exactly what is it we do?

Well, pulmonary function tests, what else? End of story, right?

No, not really. Our purpose is the diagnostic testing and monitoring of lung disorders. That may sound like the same thing but it’s a matter of focus. It still means doing pulmonary function tests (and no matter what, we’ll be calling them that for a long time), but only as a means to an end, not as an end in itself. Once you start thinking of our purpose in these terms the priorities become clearer.

Most importantly I think this means that we need to be open to performing any tests that can improve the diagnostic process no matter what they are. As an example, when spirometry is ordered what is most often performed is a Forced Vital Capacity. That’s fairly adequate for detecting expiratory airway obstruction, but spirometry can also consist of:

  • Upright and supine spirometry to detect diaphragmatic weakness.
  • A Slow Vital Capacity in order to acquire the largest VC for the FEV1/VC ratio.
  • A Slow Vital Capacity to measure IC and ERV.
  • A Forced Inspiratory Vital Capacity to detect inspiratory airway obstruction.

And how often are these performed? We need to work smarter and use all the tools in our toolbox. I’ve known technicians that dug in their heels and resisted doing anything that wasn’t considered traditional pulmonary function testing. The time for this kind of thinking is long past even assuming it was ever correct in the first place.

Accurate diagnostics cannot be based on incomplete information. This means, at least as far as I’m concerned, that technicians should have the ability to perform additional tests for a given patient based on findings as they occur. Why should a patient have to wait a couple of weeks for a PFT report to be read only to find they need to come back for more tests? A patient’s wheeze can lead to an order for just spirometry but what happens when the results clearly indicate that a restrictive disorder is far more likely instead? Either written orders need to be more open-ended or there needs to be mechanisms for a technician to quickly get additional orders.

Monitoring patients is just as important and accuracy in this means managing test equipment so that tests remain accurate and repeatable over long periods of time. It means managing patient test data also over long periods of time so that it can be quickly retrieved and compared. It also means reporting results and trends in a clear and unambiguous manner.

Re-defining our purpose will not work unless as technicians step up to the plate as well. It’s not enough to be knowledgeable about the mechanics of performing tests, we also need to understand the diagnostic purposes of the tests, the implications of the test results and to be careful and diligent when performing tests. To some extent continuing education should be a department-level responsibility as well as a responsibility of the medical director, but in the end it’s really our responsibility.

Finally I’m going to say that if you work in Pulmonary Diagnostic Services, it’s time you had your CPFT or RPFT certification and this needs to be a requirement, not an option.

We’ve all seen the upward creep in job titles. Sanitation Engineer for janitor. Media Distribution Agent for paperboy. Field Nourishment Consultant for waitress (a real job title!). Twenty years or so ago I scoffed somewhat when they renamed the hospital’s housekeeping department as “Environmental Services”. A funny thing happened along the way however, because the people in that department started becoming truly concerned about the patient’s environment and not just about mopping floors and emptying wastebaskets. As importantly they also started to have a real say in how rooms were laid out, how they were equipped and how to keep them safe for patients.

Our places of work have been called Pulmonary Function Laboratories probably since the 1960’s. That title may have made sense at one time because in the beginning at least, pulmonary function testing was still somewhat experimental and somewhat like research. That’s no longer the case and how we, and the patients and physicians we serve, perceive our profession are influenced by the words we use to label it. Pulmonary Diagnostic Services is a far better description of our purpose and re-branding ourselves this way will affect how we and everyone else will think of it.

It may only be a matter of perception but wouldn’t you suspect that our chances of getting our staffing and equipment requests approved are measurably better if we make them as Pulmonary Diagnostic Services instead of the Pulmonary Function Lab?

In a real sense, there is nothing in being Pulmonary Diagnostic Services that we don’t already know and shouldn’t already be doing. I’m not going to say that re-branding will fix our problems but it’s at least a positive step towards re-prioritizing, re-imagining, re-defining and hopefully at least, re-invigorating our field.

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2 thoughts on “Re-branding, re-imagining and re-defining ourselves

  1. Hi, Richard.

    My first position in New York City in 1986 was in a private setting with a group of pulmonologists. They called their labs “Pulmonary Diagnostic Laboratories of New York”, which I always liked. I’ve been a pulmonary laboratory supervisor since 1992, and I’ve called every lab I’ve supervised “Pulmonary Diagnostic Laboratories”; Diagnostic is definitely more relevant to what we do than Function. I don’t have a problem with the word “laboratories” (we do have Bunsen burners and Jacob’s ladders in each lab, right next to the jars of brains labeled “Abby Normal”…) but Pulmonary Diagnostic Services does sound more current. On the topic of names and labels, our credentials refer to us as technologists, not technicians. I always thought technologist sounded more advanced and “smarter” than technician.

  2. Hi Richard

    it is interesting that you raise this issue as I am in the process of re-branding for the laboratory that I manage. I concur that our staff are not merely technicians – the staff in my lab are scientists and are expected to not only perform tests but make informed decisions on the results and make recommendations to referring physicians. They are also expected to obtain a recognised professional credential. I am however, finding it a difficult task to find the right combination of words that not only have appropriate meaning but also sound “modern”. I think I might have to take the question to a wider audience and test public opinion! I shall keep you posted.

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