[Histonet] ASCP Exam Long opinion

[Horn, Hazel V]

I too had patient contact many years ago when I worked at Children's
hospital in Oklahoma City.   We went to pick up renal and liver biopsies
and got to see the procedure and the patient.  I enjoyed the patient
contact and it made me more aware of always doing my best with our
specimens.   I wish all techs could have this experience because it does
"bring it all home" that a real patient is behind every sample.

As a breast cancer survivor (over 6 years, stage III) I am very
interested in the discussions on processing breast and node specimens.
(our hospital does not get those specimens)    All of the patient's
treatment depends upon the pathology report.   I can't stress enough the
need to follow all of the guidelines for ER/PR and Her2 processing.     

Hazel Horn
Hazel Horn, HT/HTL (ASCP)
Supervisor of Histology
Arkansas Children's Hospital
800 Marshall    Slot 820
Little Rock, AR   72202

phone   501.364.4240
fax        501.364.3912

visit us on the web at:    www.archildrens.org


-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu
[mailto:histonet-bounces <@t> lists.utsouthwestern.edu] On Behalf Of Joe
Nocito
Sent: Sunday, February 04, 2007 9:46 AM
To: patsy ruegg; 'Rittman, Barry R'; 'Edwards, R.E.'; 'Jasper, Thomas
G.'
Cc: Histonet <@t> lists.utsouthwestern.edu
Subject: Re: [Histonet] ASCP Exam Long opinion

Patsy,
I am closer to you than you think. At my first lab after histology
school at 
Keesler AFB, MS, I had to assist on bone marrows and worked in the blood

drawing room when I had no pathologist. I saw how bone marrows were 
performed and it scared me to death when I had to embed and cut the
blocks. 
I didn't not want to mess it up and then have the patient return for
another 
procedure because of my mistake.
    There were many retirees in Miami that were getting cancer treatment
at 
the base. Often, the regular patients would request me to draw their
blood 
because I also joked with them and was able to get the blood on the
first 
try. I remember one lady was trying to fix me up with her granddaughter,
a 
total knockout. She had told her granddaughter so much about me that the

granddaughter was coming done for the summer. Unfortunately, the
grandmother 
succumbed to cancer and I never had the chance to meet her. The
attending 
wanted an autopsy. I was the only tech so I had to assist on it. When
the 
pathologist and I were about to start, I got teary eyed. The doc asked
what 
was up, so I told him. He told me to go back to the lab and he would get

someone else to put her back in the cooler when he was done, all I had
to do 
was clean up.
    Number 1= you are right, we just don't have the patient interaction
we 
used to. It is hard for tech to try in put a face with the block. Still,
to 
this day, 3 years later, I remember those experiences. Experiences that 
students today may or may not experience.
    Number 2= some pathologists today would not have understood and
would 
tell me to suck it up. Today it's more of a turn around time/insurance 
payment issue than ever.

Joe
----- Original Message ----- 
From: "patsy ruegg" <pruegg <@t> ihctech.net>
To: "'Joe Nocito'" <jnocito <@t> satx.rr.com>; "'Rittman, Barry R'" 
<Barry.R.Rittman <@t> uth.tmc.edu>; "'Edwards, R.E.'" <ree3 <@t> leicester.ac.uk>;

"'Jasper, Thomas G.'" <TJasper <@t> smdc.org>
Cc: <Histonet <@t> lists.utsouthwestern.edu>
Sent: Saturday, February 03, 2007 2:05 PM
Subject: RE: [Histonet] ASCP Exam Long opinion


>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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