Ensuring quality in medical laboratories.

The problems in Canada with laboratory medicine were recently discussed in CMAJ. The Canadian Association of Pathologists released a 5-point action plan following its 2008 annual meeting. We fully endorse the call for mandatory external testing of proficiency for all Canadian medical laboratories and the dissemination of a quality-management checklist for diagnostic immunohistochemistry. However, we disagree with the association’s assertion that a national accreditation program will ensure that medical laboratories in Canada will meet quality standards. A diagnostic accreditation program is effective only if participation in the program is mandatory and the program has the authority to shut down any laboratory that does not meet the established standards. Provincial governments (not the federal government) are responsible for providing and regulating health care services in Canada. In British Columbia, diagnostic laboratories are regulated in part through our diagnostic accreditation program, which operates under the authority of the College of Physicians and Surgeons of British Columbia and the Medical Practitioners Act of British Columbia. A physician operating a nonaccredited laboratory is subject to loss of licensure. The act is a powerful piece of legislation that completes the quality-assurance cycle of assessment, evaluation and corrective action. The legislation provides strong support to the directors of medical laboratories as they strive to provide quality services under pressure from health authorities to contain costs. The federal government, the Canadian Medical Association and the provincial medical associations should lobby for the creation of provincial diagnostic accreditation programs and for the passage of appropriate provincial regulatory legislation. We applaud the efforts of the Canadian Association of Pathologists to develop a system to measure professional workload. However, workload issues cannot be used as an excuse for substandard diagnostic practice. As professionals, we are responsible for the accuracy and completeness of our diagnostic procedures and reports, for maintaining our skills and for being able to demonstrate this in qualityassurance programs.