[Histonet] ASCP Exam Long opinion

Sat Feb 3 14:05:18 CST 2007

I think I am even more of a dinosaur than you Joe.
I think all the automation is taking us farther and farther away from
connecting with the patient which is after all why we do what we do.  
I came from a unique situation, early in my histology career I took a job at
the U of Colorado with Dr. Matthew Block in the department of
Hematology/Oncology.  Dr. Block was a practicing hematologist/oncologist who
also became a board certified Pathologist and set up his own histology lab
because he did not like the service he got from the pathology/histology
department.  He literally treated the patient and did his own path
processing and report.  We would go with Dr. Block to the patient and assist
with taking a bone marrow biopsy or lymph node biopsy, take it back to the
lab, process it into GMA plastic in those days because Dr. Block wanted
really thin tissue sections.  He was a hematologist who looked at everything
under oil immersion and insisted on impeccable cell morphology.  We saw the
faces of the people we were preparing tissue sections for.  I remember
helping mothers hold babies while bone marrow was taken.  I think these
experiences continue to remind me that there is a patient whose parts we are
attending to.  I know this experience is not common and certainly not
practical anymore but I think the more and more we push buttons and don't
look at our slides the farther we are removed from remembering that there
are patients we need to do our best for.
Patsy

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Joe Nocito
Sent: Friday, February 02, 2007 6:02 PM
To: Rittman, Barry R; Edwards, R.E.; Jasper, Thomas G.
Cc: Histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] ASCP Exam Long opinion

I agree with you Barry. Techs need to know how the procedure is working to 
be able to troubleshoot when something happens. Is it the machine or the 
procedure? That's what I stressed when I was giving my intro to IHC 
lectures. Something intricate like immunos should be done manually until the

tech is familiar with the procedure before they put slides on a machine. 
But, then again, I've been told that I'm a dinosaur. Oh well, it's Friday, I

think I'll have a scotch. Enjoy

Joe
----- Original Message ----- 
From: "Rittman, Barry R" <Barry.R.Rittman <@t> uth.tmc.edu>
To: "Edwards, R.E." <ree3 <@t> leicester.ac.uk>; "Jasper, Thomas G." 
<TJasper <@t> smdc.org>
Cc: <Histonet <@t> lists.utsouthwestern.edu>
Sent: Friday, February 02, 2007 8:59 AM
Subject: RE: [Histonet] ASCP Exam Long opinion

Nothing is black and white nowadays and I think that the current
discussion on Histonet is important in putting forward all points of
view..

I agree that automation is very important for producing consistent
results and in many ways these have relieved us of tedious, repetitive
tasks.
I also respect the supervisors who are often stuck between a rock and a
hard place.

The problem I currently see is that in many cases these machines may be
operated in a robotic fashion. If the individual operating the machine
is knowledgeable about the process taking place be it histochemical,
immunochemical or special stains and can take appropriate steps if
problems arise then there should be no problem.
Unfortunately in today's market, not just for histology, the emphasis
appears to be on minimal qualifications to carry out a task. This may
work perfectly well in those cases where instructions are concise and
easily followed and solutions changed at specific intervals and times
adhered to.
However, I believe something is lost to the histotechs in such a
situation.

After all I operate my car with minimal knowledge of the mechanics and
electronics. However were I to get paid to operate my car I would hope
that I had time and make the effort to try understand the processes
involved. I would consider this part of responsibilities and also a
bonus in enhancing my work experience.
My point is, are we going to "progress" into an era where we are just
button pushers?
This automation also releases individual so that many histotechs may
carry out tasks that never used to be their responsibility.
This appears to be a national trend. As an example, I am paid as a
faculty member here but my time spent includes memos, filing etc. a task
originally carried out by secretarial staff. It is not that I resent
doing such tasks but after all I am paid more than secretaries and the
"secretarial tasks" never appear anywhere in my yearly report of
activities.

Perhaps we will end up with histotechs plus a second group of button
pushers? Perhaps secretaries will be reincarnated  - probably not.

I guess that I am from an era where work was varied and pleasurable
rather than one in which the bottom line was the aim, and where employee
and employees worked as a team.
Hoe that this makes sense, this has been a one coffee morning so far.
Barry

-----Original Message-----
From: Edwards, R.E. [mailto:ree3 <@t> leicester.ac.uk]
Sent: Friday, February 02, 2007 8:09 AM
To: Jasper, Thomas G.; Rittman, Barry R
Cc: Histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] ASCP Exam Long opinion

Laboratory automation surely  is  as  much  due  to  obtaining
reproducibility of  results than  saving  on  staff costs, as  to  date
at  least, all  machines  need  human  minders, who  earn  their  corn
when  the  machine  malfunctions and  for  example they  have  to  do  a
batch  of  H <@t> Es by  hand.

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Jasper,
Thomas G.
Sent: 01 February 2007 18:17
To: Rittman, Barry R
Cc: Histonet <@t> lists.utsouthwestern.edu
Subject: RE: [Histonet] ASCP Exam Long opinion

Hey Barry,

I appreciate your long opinion, at times life requires long opinions.  I
agree with much of what you say and I will try to concisely explain how
I see things.  I totally agree that elimination of the practical was a
bad idea.  And I understand the arguments for getting rid of the
practical.  Let's start with automated staining.  Unfortunately most
labs in the clinical world of the US, Can., UK, Western Europe, S.
Africa, Aus., NZ and Japan (sorry if I've omitted someone) have turned
to this technology out of necessity.  This is due to staff shortages and
for cost containment.  The consistency and reproducibility are greatly
enhanced by reduction of variables (I know more science than art).  But
there you are, so a lab's automated stainer produces a stain, candidates
submit.  If this is the technology a candidate will likely use, that
should be taken into consideration.
I expect a candidate to cut their own sections.  That would be subject
to evaluation as it always was.  And I expect someone to know what an H
and E or any other stain is supposed to look like, automated or not.
With so much emphasis on academics they should know what the stain looks
like and why.  Heck, with all this automation you could even expect a
basic level of understanding about the mechanics involved and make that
part of the written exam.
Perhaps the elimination of the practical was not necessary, but a
reassessment of the whole thing, or as you so cleverly stated "...what
is needed for the entire system is a good enema!"  I agree with the
statements from others that they want to know that folks who are
certified can cut sections.  It is more balanced and despite all of our
wonderful automation Histology is the one laboratory discipline that
still requires a deft hand and an artistic eye.  I'm not aware of any
automated substitute for manual dexterity.
I also agree with this whole ASCP/fox in the henhouse analogy of yours.
I understand we've got good intentions here, but there is a mindset,
amongst certain pathologists, about cheap labor.  Despite pay increases
in recent years (and I'm grateful) Histotechs overall, are the lowest
paid laboratorians.  Increased educational requirements (which I believe
in) still have not eradicated this mindset.  Please understand, I am not
speaking about all pathologists, but there are enough to validate the
analogy.
Now Barry, I think your educational background is great and I suspect
you're a better man because of it.  It seems to me in this day and age
that it would be near impossible to pull off.  We've taken incredible
leaps in technology just for Histology alone.  I would be wary of an MLT
or MT today that thought they could come into our Histology lab and
perform at the level I expect (that whole dexterity thing again).  And
frankly, I think it would be extremely difficult to go into the General
Lab, Blood Bank, Chemistry, Special Hematology, Microbiology or any
other sub-discipline and perform at an acceptable level.  Now do I think
folks should have an understanding and appreciation for these other
disciplines?  Absolutely.  And maybe that needs to be incorporated in
Histology training at an academic level.  But doing the work is another
thing entirely.
Anyway, I don't know if my opinion will count for much, but there you
have it.  It would be nice to see some changes and I think reinstating
the practical is worth considering.  I understand that logistical
problems exist as well, along with some of the other subjective
variables that Joe Nocito mentioned.  Maybe judges could be sent
regional sites or something.  Anyway it's food for thought.
Thanks for letting me ramble.

Thomas Jasper HT (ASCP) BAS
AP Supervisor
SMDC - Duluth, MN

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