History of the Medical Laboratory Science Profession with Elissa Passiment

[Music] Off the bench is a podcast created by ASLS. That will discuss the scientific and not-so-scientific ideas in laboratory medicine. We are joined by members of ASLS, fellow scientists, educators and researchers, along with those interested in the profession. We share ideas and talk nearly. And welcome back to the Off the Bench podcast. I'm Sophia Chandra Sikar, one of your hosts. And today I am joined by someone absolutely wonderful. And we are going to talk about the general history of the laboratory profession, Alyssa. Would you like to introduce yourself? Hi, I'm Alyssa Tassman. I am a medical laboratory scientist, been one since 1969, long, long time. I have worked at the bench. I worked both as a person just in the chemistry department. And then I went on weekends and nights and evenings. And so then I worked hematology, chemistry, blood bank. And of course a little bit of micro. We never did lots of micro on weekends and nights in those days. And then became an educator of a mid-tech program. In a hospital-based program. And a lab manager went on to do healthcare consulting with a consulting firm in the United States and Canada. And then went on to be the exact for the American study for clinical laboratory science. It's an amazing sense of history and the laboratory profession. This is why I think you're one of the best people to talk to you about. Just a general history of our profession as well as why laboratory people are just so awesome. Yeah, if it's one thing that I learned throughout my career is why we matter so much. When I was in college, the program I went to at the University of Buffalo had a couple of really militant medical, oh, we were called medical technologists at the time. These women had been working in the field for a long time. They had been part of the group that moved us from being the technicians that started in the early part of the 1900s, the late part of the 1800s, to being trying to become a profession as opposed to just being a physician's technician. And they had spent a great deal of time on that. And all of them actually, Karen Karney, Sarah Cicarelli, they all really felt passionately about the profession. And what they taught us, and at the time, we did not realize they were ahead of their time, they taught us that we should partner with physicians in helping them take care of their patients because we really had some key information that patients and docs needed, and that we actually could sometimes see something that the doc wouldn't normally. And I took that to heart when I first started to work. I worked at the VA hospital in Buffalo. And when a patient had a problem or a doc was having a problem with the patient, and they'd call the lab, and they got me on the phone, and they were asking about results or something, I would actually try to have a conversation and explain either what they should do next or what it meant, or that they had ordered the wrong test. And I got myself into a lot of trouble. It just sounds to me like you're part of this whole, we are all on the same team of providing care for these patients. And we see things that, like you said, we see things that doctors don't see. We also see things were often the doctors don't see. We're used to seeing things like anemia cells, different types of blasts, different types of weird analytes, and different patterns, and almost like algorithms. And being able to have that conversation, you're a part of the movement forward of making sure all of this was actually happening. Oh yeah, I mean, first of all, back then, we were also the subotomy team. And those days, we did everything. And so I would draw blood on a patient. And the doctor would say he wanted a sedate. And I go, I'm sorry, I just drew the blood on the sky. He's got a fever of 104. You don't need a sedate. I also, because he has a fever of 104, ran back to the lab and did his white count. And he's got an 18,000 white count. The sedate is elevated. Just, you know, don't worry about the sedate. So of course, you know, I got written up because he wants a sedate. But he didn't need that. What he needed to do was figure out why this patient had a fever and an 18,000 white count. Okay. And, you know, I had one doc call. He wanted a sedate. You know, that was my favorite test. He wanted a sedate because he didn't know whether to admit his patient to the med surge floor or the renal floor. And I said, Doc, your patients got urine that looks like prune juice. That's how dark it was. I can promise you that his sedate is elevated because his urine looks like prune juice. Okay. And he's got both hemoglobin and red cells. So you don't need the sedate. You need to decide whether you think this is happening in, you know, post as a team. In other words, after the kidneys, I eat somewhere in the urinary tract. Or if you think it's in the kidneys, I'm happy to, you didn't order it, but I'm happy to run some other tests like creatinine, you know, be it electrolytes, see what's going on with them. And that might help you out figuring out his kidney function. And of course, you know, he wasn't happy with that. And, you know, and one time we had a patient who was out had been on the floor for a long time at the VA hospital, patients stayed for a long time in those days. And he had a crit of 44. And the doc ordered three units of whole blood. Oh. So I went over to hematology. This is the weekend. So I went over to hematology because it's me. I'm, you know, so I ran over to hematology and looked at his blood smear and didn't see any reticst and see. So I figure, okay, if anything, he's actively bleeding. So I called the doc and said, with a 44 crit, whole blood's not the answer, but I, you know, I can pack some cells for you, but I don't know that you want three units of this. Is he actively bleeding? Is he, you know, spouting blood from somewhere? And he's like, I, you have to give me what I ordered. I said, oh, no, I actually don't. And I won't be doing that. And if you like it, you can come down and sign it, but I will let sign it out. You'll have to pick it up against my judgment. And my lab manager happened to become, came in that weekend and he walked by, said, by the way, I need to warn you. He'll probably be another incident report. But the point was that even them, even though our laboratory tests were nowhere near as sophisticated as they are today, we still held the key to, and we'll always hold the key to what it is it's going on with the patient. Patients have this bad habit of not presenting the way the books say they're supposed to. And in all deference to the physicians, you can't, they can only go by what they see initially. And, and, and, and, and then hope that they're on the right track. And then hopefully what we tell them gives them an idea if they are on the right track or if they have to rethink. In the, when we first started out when this profession was in, in its infancy, many of the laboratories were on the hospital awards. Really? Yeah. Back in the very early 1900s, labs were actually on the awards for the longest time, the docs did their own tests. And then physicians decided that, you know, they couldn't, they couldn't devote the time they needed for that. So they started handing it off to the interns or the medical students. But then even because the science was growing, especially in, in bacteriology and in chemistry, they needed, they needed the interns to be doing their jobs actually. So they started looking for who else could help. And, and those days, women who are interested in science had very few options available to them. If you studied science in the late 1800s, early 1900s, people thought, no, I wasn't that cute. She wants to know science. So, there's an understanding. and the flowers and the garden, and it's like really. So for those women, if they wanted anything in medicine, they weren't getting into medical school, right? The option where these scientific jobs is working up in the laboratories for these physicians and doing their tests. And that's frankly how most women got into the hospital laboratories. Now over time, the labs themselves got to be too big because the science got too big. And so they found some place else in the hospital for the lab. Unfortunately, a lot of times it was in the basement, but what do you do? And more and more women heard about this. They actually advertised for women who had an interest in science, who had taken some basic science courses in college, et cetera, and then they would train them on the job. And that went on for quite a while. So that's why in like 1932, 1936, in that timeframe, the women who were in the profession decided that they needed to, they needed an organization where they could talk to each other. Right. And so that's when they formed the American Society for clinical laboratory technicians. That's what it was originally called, ASCLT. ASCLT. Okay, yeah, believe it or not. But in the meantime, the science kept growing. Right. The women who were doing the work realized that some of it needed to be standardized. So they started to write papers about quality control papers about how to do certain methods so that they were reproducible, regardless of what laboratory you were in. They started talking about a scope of practice. They didn't call that better than time, but that's what they meant. Right. So they really were starting to codify what was happening in the laboratory and to be honest with you, physicians were starting to learn how to use the lab. Remember, Wittebski started his work on the ABO system back in the '30s and early '40s. And he was able to show that if you just did a couple of simple tests, you could safely transfuse people who in the past would have been transfused with the hopes that it didn't hurt him. And, you know, because they didn't really understand compatibility, I actually got to meet Dr. Wittebski during the night. I know he worked at, in his later years, he worked at the University of Buffalo and worked at the Buffalo General Hospital. And that's where I did my microbiology rotation. And I will never forget that it was like a. Like a midi-duty thing. (laughs) - Like me rockstar. - Yeah, he was a rockstar. - Oh, oh. But the point is that it became very, very obvious, very, very quickly that we really did hold the key to knowing what was going on with the patient that without the laboratory test, of course it had to be the right laboratory test. But without the laboratory test, docs could miss a lot. - When I was reading this, the tracing art roots, articles written by Virginia Kotler, I'm so sorry, I can't remember. Kotler's, one of the things that stuck out to me was like how we were semi-professionals. The professions are now as for semi-professionals. And that, again, going back to also the, oh, how cute you want to learn science for your flowers. - Right, yeah. So it was considered a semi-professional thing because it didn't quote unquote, meet the definition of professionals. But a profession is a, and Virginia does cover this in another one of part of her article. And it is a, there are a number of definitions about what constitutes a profession. But everybody agrees that a profession is a calling that has a defined scope of practice that within that practice, you have to use independent judgment to actually do whatever it is that the profession claims to do. So the argument that, and so in 1992, there was a case brought by a medical technologist and from the state of New Jersey, who was angry because the union was trying to unionize that particular guy's hospital and they were lumping the laboratory folks in with like housekeeping. And he was like, that's not okay. We are a profession. We should be lumped with pharmacy and nursing and respiratory, et cetera. And he took the case to court and it went to the National Labor Relations Board, ASMT at the time, filed what is known as an amicus curae, which is a, that's translates as friend of the court brief. And we explained why we believed that we exercise independent judgment. But they were hooking the idea that we weren't a profession on was because the lab was automated. Well, yeah, the lab was automated. Chemistry and hematology by that time had become quite automated, frankly. However, blood bank and reading of any slides in hematology, all of microbiology had yet to be automated. So none of that was, all of that included for us to do what we're our job, our independent judgment. And we were able to prove to the National Labor Relations Board that we were a profession. And from that time on, there was no more argument about it. But prior to 1992, there was quite a bit of discussion about it. And frankly, we argued among ourselves, we argued with pathologists, we argued with PhD scientists. It wasn't a pretty time trying to get recognition for being a profession. But I think, I know that that day's gone. But I don't think anybody today, there is anybody who doesn't understand that what we do, what our work comprises is a profession. - One of my first experiences as a student with, was a doctor over the phone, was actually them just asking, "Oh, why can't you just push about it and give me the result for something?" And just thinking about that and realizing that they don't fully understand what it is we do. I remember, I think it was a potassium due to homolysis and he's still one of the results. And I remember, as a student, explaining to him, well, if it's humanized, we can't, but why can we not? And explaining to the homolysis and potassium and versus internal cells versus outside of cells. And it was, I remember him being very surprised that we would even know something like that. And not the greatest. - I'm the brightest, right? - Right. Not exactly the greatest first interaction with it. First, it was the first time I picked up the phone too. So, it was just very nerve-wracking. And as a student, I was extremely confused. I was like, "Why does he not know?" But I did not know. I thought doctors knew everything. Of course, now that a couple of years into my career, they know what they know to do their job and we know what we know to do our job. And we have to put our two sets together to provide a better full picture. - For sure. - Correct. And the sad part about it, I was part of a CDC group that for a number of years, Gale, we probably worked on this for over seven years. - One of the things we did was we actually a survey of all the medical schools in the United States and ask them how they teach laboratory medicine and laboratory science. Okay? - Okay. - Okay. Less than half of them have a formal course in laboratory medicine or pathology. Less than half. - Oh. - Right. And of the ones who do have a formal course, 25 or 30% I'd have to look at the actual study, but 25 or 30% of them, it's only an elective. Oh. A six week elective, that's it. Can you imagine trying to cram all that you and I know into a six week elective? - I know. - Right. - So then we dove a little deeper to find out. Okay. you teach laboratory medicine and laboratory science. That's cool. So how do you teach it? Who's your instructor? You know, what is the, what do the classes look like? Do you have any labs? Do you do any? So for a lot of them, they believe they're teaching lab medicine because during the third and fourth year when the students are in clinic, the residents are teaching them which laboratory test to water. Oh, you're like, uh, excuse me. No, no, that's not what we mean by teaching lab medicine lab science because what you're doing is perpetuating the same bad practices. Those residents were taught during their medical training, okay? And and and the and and depending on where where they were trained depends on whether they used shotgun approach or whether they were the type, you know, you order like one resident showed me one time. What he knew about laboratory test fit on a three by five cart. He literally had electrolytes, CBC, he had listed, okay? And then a couple of other tests by Oregon on a three by any carrot in his lab coat. And that's how he ordered laboratory tests. I'm surprised the third year and fourth year is where for some people it's the first time they even hear about it. That's that's well into your medical career. That's or medical schooling. And at that point, you have your preconceived notions of what things should be of what you should order for what based off of what clinical picture you don't even look at maybe, you know, uh, like look at the box essentially, right? And that that almost and I see how that encourages definitely the shotgun method because you don't really know what you're doing. It's just, well, based off my index card, it looks like maybe I should be ordering these tests, right? And I and also when they go on rounds, you know, when and and they're asked, what lab tests would you order? If in many cases, if you don't like give a whole list, then the attending gets jumps on you and you know, oh, you forgot this test, or you forgot that test. And so these guys and gals are kind of like trained to order more just so they don't get yelled at kind of thing. They're the reasons why we have a new sedrate machine. So my one of my most favorite pathologists that I've ever worked with, uh, Dr. Elliott Krause, he and I used to talk about sed raise and what a stupid order it was. Well, he became the director of the laboratories at Princeton Medical Center in New Jersey and he decided he's going to fix this problem and he announced to the hospital there will be no more sedrate so it's order. Unless you call me and then he then went to his specialty guys and said to them, neurologists, you can order a sedrate because you're trying to decide whether a patient's got temporal autoritis and that's the sedrate will be elevated and there won't be much else that will tell you what's going on with the patient. Got OB/GYN guys. If you think you've got a, a tubal pregnancy, order a sedrate because that's one of the ways to find out rheumatologist, you know, your patient seems to not be responding to their medication. It seems to be relapsing. You can order sedrates. Everybody else, no more sedrates. And I mean, to this day, I have him like on a pedestal because my feeling is this man, first of all, he was always very, very smart. But now this guy was brilliant and he did it right. And there are no, no, I don't know what's happening today. I don't know if he's still directing the laboratory. But while he was there, he actually went through two lab managers because, you know, they moved on and I met one of them at one of our meetings and he said, "Oh yeah, nobody orders sedrates in our hospital." That's amazing. That's amazing. Yeah. Absolutely amazing. The small culture changes that really, really push things forward. Oh yeah, because his thing was, you're wish in my time, order something that the patient will really tell you something about the patient, knock it off with the sedrates. Get a therapy, get a tripon in, get a CKMB, get the things you actually need that we already know correlate to things. Right. Procalciton in get, do something, every extent, it's going to tell you something about the patient. Yes, yes, yes. So yeah, I have to admit, one time we had a patient come into the hospital and he had, he was complaining like a just general visceral pain. He couldn't, he couldn't localize where he heard, okay. And so of course, the doctor sort of wanted everything. It was just okay because they couldn't figure out what was going on with him either. And so, you know, CBC, three units type in cross, really electrolytes, creatinine B1, okay. So I thought, let me start with the electrolytes and a CBC. One of those is going to tell me something and sure enough, his electrolytes, his sodium was 126. Oh yeah. That's so low. Uh-huh. His potassium was, oh, golly, it was like close to five. And so I said, okay, we may have some problems here with kidneys, right? So looked at the creatinine. It wasn't elevated, the B1 was elevated, but you know, the creatinine takes a while to go up. So okay. He decides he wants a random creatinine clearance. I said, what? Yeah, I want you to do a urine and a serum and calculate a clearance. I said, no, I don't think so. So he called the pathologist who event said to me, do it anyway. And I said, well, no, let me, so I called the nephrologist who by this time, you know, had gotten used to me. And I said, he's got a 126 sodium and he's got a fill almost a high potassium. If his kidneys are functioning, he should have not much sodium in his urine because his kidneys are trying to save the sodium, right? Great. And he should be peeing out potassium, right? And then the neurologist said, absolutely. So instead of, so that's what I did, I ran urine electrolytes and sure enough, that was he, he was saving his body, was trying to save sodium and peeing out potassium. So I thought, okay, now it's the time to look at something else. So I ran, he had ordered a CK and a couple of other, and I ran the CK and it was elevated. And the Mb, the guy was having a coronary, why he had general visceral pain, not sure. But the electrolytes, you could understand why the electrolytes were unbalanced because of what was happening with his heart and called the physician and said, you know, this is what we've got and it's not as kidney as it's his heart. Luckily, he had calmed down by that point. So the next day, of course, I was drawing the man's blood and he was hooked up to all these machines and stuff like that. But the fact is that it was, you know, we could do that because we understand all of what's happening in the body. You know what I mean? And we're not focused, we're not yet focused on one organ necessarily, because we see the patient as a whole patient. Docs sometimes when, especially in an emergency, and I'll give you that for them, they'll see, they'll see them by organ. Right, right, you know, because they're trying to catch things before they get bad. And all of that makes perfect sense. We have the ability to be just a little bit more objective and go by data, because we're not seeing the patient's frame and polarity. Right, right. We have that other perspective, and are less, not so much blinded because they're obviously not blinded. They see the patient from them, but we have the, I'm sure to many people's relief. We have the fortune to not be by the patient's bedside to assist from a far distance away from the people and provide these, provide all the data. And everything, everything that happens behind the scenes, really. Right, so we can be a little bit more objective and that, and, and I think personally that we can add some calm to a situation, because we can help them figure something out without all the noise is going on at the patient's bedside. Right, right. So with your history of ASCLS, what role would you say ASCLS has played in the profession, aside from the fact that we were pretty much there from pretty early on, but just from the leadership academy, from listening to the history of ASCLS as well as profession combined, ASCLS to me has done so much to really drive our profession forward, especially with that union trying to lump us in with housekeeping, which are amazing people and amazing, like what they do is so important, but also at the same time, like, you know, what we do is different. We are a profession, you know, where has ASCLS like with ASCP and B.O.C and all of our combined histories, how have we driven things forward? Well, we, what that, the organization has done from its inception is tried to make sure that the people doing the laboratory tests were a educated, be recognized and then see given the opportunity to help advance the science. So from the beginning, when they were called the American Society for Clinical Laboratory Technicians, what they were trying to do in those days was standardize some education, because there were still a whole host of different ways that you could become a technician. And that was what we were called in those days was technician. You, there were private schools that you could pay lots and lots of money to and become a technician who was training was sometimes suspect. But there were physicians who were hiring women right out of high school, just because, you know, they seem to be smart and training them and training them maybe well and maybe not so well. And so the very, very beginning from the birth of the organization, they recognize the need to have some formal education and for that education to be somewhat standardized. By doing that, by even just recognizing that they were laying the foundation for this to become a profession. And then throughout the 30s and the 40s, they were the ones who were arguing with the armed services trying to get. And the people in our profession recognized in the armed services as officers to get additional training to qualify for GI bills and that sort of thing. They accomplished that by sometime in the early late 40s, early 50s, and then started to look at what it took to really. And then set up a laboratory practice effectively and safely. Again, a lot of it was was looking in at what we were doing as opposed to looking out to the patient yet that would come later. But that needed to be done that way so that we would not now not only have the foundation, but start to build. And then we had a virtual structure of a profession, which included a lot more science than what would it was originally thought. And then frankly, they started to. And the fact that we do most of our work unsupervised. The pathologist continued to insist that nothing happened without them. And the laboratories were saying, I'm sorry, but you're not standing there right next to me while I'm reading this slide and you're not there. Well, I'm speaking this plate. I'm on and on and on. You're not there while I'm running these tests in chemistry. You're, you're doing anatomical, which is fine. That's part of that's part of the whole profession, but you're not. We can work do this without you. Right, right. And so. And we spent a fair amount of time now again, I wasn't around for the 50s as far as, you know, being in the profession was concerned. But in the throughout the 1950s, the folks in the profession and pathology were constantly going back and forth about everything from who should be on the board of registry. And so, you know, the day the board of certification used to be called the board of registry. They were the ones who did the exams for you to get certified in those days, anything, anybody with an associate degree could be certified as a medical technologist and folks were saying no, the field is growing too fast. And so, you know, we're not really complicated. We need more study. So there was that argument in addition, the board of registry was primarily made up of pathologists. And so they spent a great deal of time arguing about the need to be more of us. And so, that's not you. So therefore we need to be on the board of registries more so that we need to be the ones constructing the exams and on and on that went. And at this, and also by the same token. And manage the laboratory ourselves. We don't need you to manage the laboratory. So a, an asmt, the women and and men who were an asmt were the ones who were leading this argument. And so, there really was by the 1950s, the American medical technologist, that group existed, that group had existed from back in the 1930s. But other than that, the AACC, for instance, the chemist group didn't, didn't form until the late mentally 1940s, ASM didn't form until the 30s. And we were really the laboratory profession for the longest time until things got to be very specialized, et cetera. And asmt had this vision about what we needed to be and they were the ones who spent the time all the time, making sure that that vision was if not. And at least we kept sight of the vision, even if we the reality didn't always match. They were the ones who pushed for the baccalaureate degree in the 1960s. As a requirement to be a medical technologist, they are the ones who came up with the idea of the medical laboratory technician as the two year degree so that both groups. So because there was enough work for both, right. They even started the discussion for the clinical lab assistant, which kind of has gone by the wayside or you could argue has been replaced by the phobotomous but, but be that as it may that is. This group, this organization has a long history of standing up for the profession and for what what we mean to medicine. And the idea of the concept that, as I've always said, we are the science of medicine. And we it is that is our purview that is our scope of practice. So they started writing papers about codifying the scope of practice codifying competencies levels of practice. This went on all during the 1970s and 1980s. And it was a lot of writing that on those days it turned out to be a wonderful thing because as I told you, when the national labor relations board was looking at us, we had all that documentation to show them. We did leave the board of registry in the mid 1990s and form the national certificate credentialing agency to, because we said we should be credentialing ourselves, we don't need pathologists to be doing this. And that organization existed until 2009. So, ASELS has always had a vision of what this ordinance, what the profession should be like, what our role is in medicine, what our role is with patients, where the ones with the code of ethics. I don't know if you know this. We are one of the few professional groups that has a code of ethics. Really, both respiratory therapy, physical therapy, and I'm trying to remember there was one other profession that actually contacted us when they were writing books about their profession and asked permission to use our code of ethics as an example. - Yeah, as an example of what a co-div ethics should look like for a profession. Wow. - Wow. - Oh yeah. And that's ASTLS, it's all this organization's doing. - Which is all the more reason why people should join. So if you have a join, you should join. But, wow. I keep telling people at my work and trying to get more people to join the profession, especially young students. And as to why they should join. It's like you, at the moment, may not feel like, you know, much is happening. But when you're a part of something this big, you will make positive change and you will make it better for the patient. Because at the end of the day, we all work for the patient. And by having things like the, I actually recently saw this at my job, where they replace all of our screen servers with this rotating side show stuff. And I'm trying to remember what the study was. But it's about the, about conserving blood, the Choosing Wisely program. And that has, and I remember reading about it how ASTLS is part of that. I know someone who's on that board, on that committee, the Choosing Wisely committee. And then now I'm seeing it actually at my job. And it's being promoted at my job and being like shared with all of our doctors, nurses, just a reminder of like, you know, what to do in, for these cases. And at the, I remember thinking, you know, I don't know where this, when I first read about it, I was like, you know, this is interesting. Because it was right when I had started joining ASTLS. And I was like, I don't really know what ASTLS does. And to me, it's so cool to see something like a project like that or like a committee like that, making so much change that it's now like instituted. - Yep. - Across board. And yeah. - That's true. Things that frustrated us in our professional lives, you, with ASTLS, you can come to the organization and you can talk about it. And the odds are good. You're not the only one who's been frustrated by something. And together ASTLS brings people together who then collectively decide how this should be handled. How should there be a paper? Should there be a statement? Should we be writing a letter, doing a letter writing campaign? It depends. There's no one answer to any of this. But the one thing that cannot, will never happen is you can't resolve any of this if you're not speaking with one voice. And the only way to do that is to belong to the group that is doing the speaking. A lot of folks think that they have to belong to ASTP and ASTP is a wonderful organization. But in the end, that organization was born for the pathologist, that's who started that organization, that's who will in the end still be that organization. If you maintain that you are capable of independent practice, then you have to be in an independent organization. And that's ASTLS. And it is incredibly important. What I keep telling folks is we started out as technicians and as an individual who is meant to assist a physician in doing laboratory tests. And they were very manual, very simple tests in those days. And we grew as far as the number of tests as the science grew. And then the need became great with as far as patients were concerned and that led to the automation. And everybody thought the automation was going to like replace us. It didn't replace us. In fact, the automation made us even more important because now we were putting out more tests, even quicker than we were before. And there was a need for somebody to make sure those tests were right before they went out the door. And that was us. And then the science grew. And I'm going to tell you, I know this from the CDC projects that I have been involved in. The science has grown to the point that physicians can't keep up. The names that we have given to genetic tests, for instance. We like those names because they like, they'll tell us what's SNP or what location on the DNA molecule or what amino acid is being has changed. The docs, on the other hand, look at it as a goblet book of alphabets with a number of tooth thrown in. And they have no idea. And then we find that the EGFR is not only good for cancer long or the colon or the kidney, but we can do this with it. And the doc is like, but EGFR, I thought that was estimated glomerule filtration rate. What the heck is EGFR? Okay. We know what we mean. They're like, you know, you've messed me up now for good. We love Braka. I can tell you that there are very few physicians who can tell you what the letters stand for. So we have now got so much that we can do for patients. And physicians are overwhelmed. They, as one group of physicians that we held a focus group for said, I order a fixed number of tests that I am familiar with that I know what the results mean. And after that, if I can't figure it out, I gotta send the patient to a specialist because I don't know what to do next. Well, there's good to that, but it also increased healthcare costs when it's possible that the patient didn't need a specialist but just rather a different laboratory test. And where are the ones who understand all of this? No one else understands it the way we do. So we have got to, we have got to be willing to talk to docs because we used to think that the doc was our customer. That's not true. The doc is our partner on the healthcare team. Our customer is the patient. - Mm-hmm. - Okay. And we have to remember we are taking care of patients. We are not taking care of the doc, we're taking care of patients. We and the doctor and the nurse and everybody else is taking care of the patient. And the only way that we can do that effectively and efficiently is to do our part, which is the science part, the laboratory testing part. If we leave that up to somebody else to do the ordering and the understanding of the results, patients are not going to be treated the way they need to be treated. And that is a major concern of mine because I mean, I'll be honest with you, I entered this profession because I didn't think I wanted to take like touch patients and that kind of stuff. (laughs) And I am not, I can be a little, not a little, I know I can be very abrupt. I am, I'm not anybody's, you know, like one of my professors said, do you know what TLC stands for? And we all looked at him like, "Uh-huh." And he said, "If you think it means tender loving care, you're in the wrong profession. Go transfer to nursing." (laughs) If you think it means thin layer chromatography, this is your profession. (laughs) And I kind of, I mean, I took that to heart. I was like, "Oh yeah, okay, fine, I got it now." But things have changed. And would I have been written up less if I'd been a little nicer to the docs I was talking to properly? But, you know, we weren't taught how to communicate. (laughs) Today, I would like to think that, you know, we are starting to realize we need to teach all of ourselves and our new students how to communicate so that we can take part in the health care team and not annoy people. But having said all that, there are a group of us and will always be a group of us who have got to be willing to put our arms around, the physician, the nurse, or whomever and say, "Let me help you. Help your patient, help my patient. We're all going in this together." Right, we're all on the same team. - That's right. - Yep. So, if you could have one pie in the sky dream come true for the profession, what would it be? What would you love to see? - Well, I would love to see more DCLSs, to be honest. And I guess my real pie in the sky, my review. real pine sky would be the next time that there is a pandemic or the next time there is some major concern about a particular healthcare condition that the person that they're interviewing on TV is us. Where do you remember quite a few times when my mom would call me and tell me yeah I saw this on the news according to a doctor about your testing. Yeah and the amount of times I would have to explain to her that's actually not entirely true there is more nuances to it. If I will say the one one of the I mean there are not many positives in this pandemic but one of the positives is that at least people are more recognizing the laboratory more. They still may not fully understand it because now they just think it's all COVID testing at this point. That's all we do is just COVID and that before we didn't do much. Right. But at least there is recognition of there are people behind the scenes there there are people working on things. That lab is not just when when the doctor says I'm sending your blood off to the lab it's not a mysterious box that they send it to. There are actually people there doing things. Actual medical laboratory scientists they're doing things. But it would have been wonderful if some of us were being interviewed to explain the difference between the PCR and an antigen and an antibody test. You know so instead you've got some infectious disease guy doing an explanation and I'm sitting there going well that's not exactly correct but it's closer than the other guy. So you know I just yeah that's that's my big dream is that when they the next time they will actually call the lab and ask somebody to talk about it. So for instance one of the problems with with SARS-CoV-2 are coagulation issues. Did you see anybody talking about? Not a fact. I do not think. Yeah I remember actually um I was like I yeah she was she's one of those who she's only think she listened to is the news right or reason you speak or anything I say it's always but the news said this and I remember having to explain to her about how the testing shortages were more than just COVID test shortages. Now more than just reagent shortages and more than five head shortages that we're also having major issues in the sheer amount of dimers we're going through. She might not find brain and jam we're going we're just like running through these tests like it's nobody's business and she was like I don't even know what that means. Why does that even matter? Right we need a George Fritzma on TV. Yes that'd be great. We need a U Anna George Fritzma on TV. That's what we need. We need both of you guys. Someday I hope. One day one day. Yeah yeah well thank you so much for talking to me about a general history of of the profession and I do you realize for our listeners it has jumped all over the board but that's how good conversations go you know you go or the flow you'll go over the flow go with the flow and also see how my sentences are going to come out about today it seems like. Well thank you for asking me to do this Sophia it is always wonderful to talk to you and I just and I love I love this profession so I love talking about it so thank you. Thank you and thank you Alyssa so much for sharing your passion with us today by the profession. You're someone I personally look up to in the profession and I love talking to you also also your shelf is so cool. Oh my all the laboratory books and yes that's like you know it's true lab people you have lab books on your bookshelves. Oh yeah. Yeah and then my chocolate sign is actually chemical symbols filling out. Oh I adore that. I truly adore that because that's my favorite thing is chocolate. We have a side at our lead tech office that says have you done science today? Yes no if you haven't done science go do science but if you have do you deserve chocolate? Have you had to fix something? Yes you deserve chocolate. No you still deserve chocolate. That's a good sign. I love it. Well thank you so much and listeners if you want to hop on and join the discussion and talk about anything else relates to the profession or if you want to know more go onto our Facebook page on ASL's Facebook page leave a comment in the comment section or you know tweet at us. Alyssa do you have a Twitter account at all? No I'm sorry I don't I'm only on LinkedIn I'm not on a well you can find the list on LinkedIn then and send her a message and ask her questions. I am on Twitter and I attempt to be on Twitter I'm not the best at it. I am at Warbler W-A-R-B-L-E-R that works. Sorry no Warbler underscore works. I forgot there are no dots on Twitter. So I'm a Warbler underscore works on Twitter so you have to feel free to shoot a message and we'll keep talking. Thank you again Alyssa thank you so much. Thanks to be on take care. Thanks you too. Bye bye. [Music]