Category Archives: Science

Are There Any Questions?

Over the past few months, I’ve been preparing for Lab Week by collecting questions from my friends and readers about laboratory work. I’ve done my best to be honest, because the point isn’t to trick people into joining the ranks of Medical Laboratory Scientists by painting the profession in a prettier light than it deserves. I love what I do, and my goal is to educate folks on what I mean by “what I do,” and how I got there. If that inspires anyone to look into laboratory work as a career, that’s an excellent bonus, and I encourage those folks to pipe up with any other questions they may have.

What sort of school is required for the job (in the US)?

That’s a tough question, because “the job” can mean a few different things, and different schools handle Medical Laboratory programs differently. Most hospitals prefer to hire people who are certified by the American Society for Clinical Pathology (ASCP), so if you’re considering a laboratory career, their website is a good place to start. This link will bring you to their certification section, where you can look into the various requirements to sit for the exams and earn a certification. There are several different certifications, and several ways to qualify for them, depending on your level of education and experience. In a nutshell, you qualify for certification as a medical laboratory technician (MLT) with an associate’s degree, and a medical laboratory scientist (MLS) with a bachelor’s degree. The difference between the two, in practical terms, varies a lot. Many employers will give an MLS a higher salary than an MLT, reflecting the extra years spent at school, but some places don’t bother to differentiate between them. If you’re looking to move up into management, keep in mind that most places will require the higher degree for supervisory or charge positions. You can also choose to certify in only one sub-specialty of laboratory science, like biochemistry or microbiology, but that will limit the areas you can work in, and all the schools I know of prepare you for the “everything” exams.

At school, you’ll learn chemistry and biology and math and physiology, with a little bit of computer stuff and instrumentation thrown in. In my limited experience, a bachelor’s level program will go deeper into the why and how of laboratory testing, but a graduate of a 2-year program is no less equipped to do the actual work. There are sit-and-take-notes classes, of course, but also many hours spent in the school’s labs, learning techniques. Hospitals sometimes donate their older equipment to Medical Laboratory Science programs, so students get a chance to work with the instruments instead of just learning things theoretically. See if the school you’re applying to has an internship program, or if you need to find work experience yourself. Internship programs are great because you get a feel for what the lab is really about, and employers get a free trial of you as an employee, so there’s a chance you’ll get a job offer out of it if you impress them.

Is it a good long-term job, or do most people get into it temporarily on the way to something else?

I think it’s a great long-term job because of the job security. The laboratory workforce is aging, and there aren’t enough new techs graduating to fill the positions left open when people retire. Hospitals are doing their best to cut back and make do with fewer techs, but the fact remains that someone’s got to run the laboratory if the hospital is going to provide decent health care, so laboratory personnel aren’t going to be downsized out of existence.

I’m happy that I made this career choice mostly because of the built-in flexibility. Because hospital laboratories are running 24 hours a day and never close, there are an incredible number of schedules to choose from. There are usually three shifts – days, evenings, nights – and some hospitals even have some swing shifts that fit somewhere in the middle. You can work full-time or part-time. You can work only weekends. You can be “PRN” (which means “as needed”) and get called to fill in gaps in the schedule when people are sick or on vacation.

Not everyone shares my opinion about how good a career choice it is. Unfortunately, the pay for most Medical Laboratory Technicians and Medical Laboratory Scientists is far less than for comparable healthcare professions, like radiology techs, nurses, and pharmacy techs. Here’s the most recent data from the US Bureau of Labor Statistics. Because of the lower wages, it’s difficult to keep ambitious and talented young people in the field. Many younger techs I’ve worked with have used the laboratory as a part-time job while they go back to school to pursue advanced degrees in the hopes of moving into nursing or pharmacy. Let’s just say that the med techs who stick with it long-term are definitely not in it for the money.

How much continuing education do you have to do? How well does your employer support it?

To maintain my MLS certification with ASCP, I need to complete 36 education credits every three years, spread across different areas of laboratory work. ASCP offers some online activities to help me earn credits, but unfortunately most of them aren’t cheap. I try to look for free educational activities through vendors and other professional organizations. There are several ways to earn credit, including attending college classes, publishing a research paper, serving on committees, or attending lectures. The amount that an employer will chip in for educational activities varies a lot – education is often one of the first casualties of a shrinking budget. I’ve heard that some hospitals are very diligent about keeping their techs certified and helping track their education credits, but I’ve been more or less on my own so far.

If you’re employed outside of the hospital world, certification maintenance is less important. Of course, keeping up on developments in your field of work is a good idea either way.

How much of your work deals with software?

Laboratory computer systems are interfaced with the hospital’s information system so that tests can be ordered and reported electronically. Especially in hematology and chemistry, tests are mostly run on large analyzers which are hooked up to the computer system, so the techs only need to accept results on a screen before they send them on their way. You definitely need to be comfortable with learning how to work with new software if you’re going to work in a modern lab, because the instruments all have their own operating systems, and most of your day will be spent ordering and reporting tests on computer screens. The more you can learn about how to make the instruments do what you want, and how to fix little issues that arise, the less stressful your work shifts will be. Of course, none of that helps you when the computers crash and you need to do it all on paper…

Do you have to wear different levels of protective clothing depending on the test?

I’m always wearing gloves and a lab coat when I’m handling specimens, because it’s safest to assume that every specimen may be positive for something infectious. Where I am right now, all the blood I work with has tested negative for all the bad stuff, but it’s important to remember that only means “the bad stuff we currently know about and test for.” Blood wasn’t tested for West Nile virus or Hepatitis C twenty years ago, and I have every reason to believe that some new bloodborne disease will become an issue in the next few decades and I’ll find out that all this blood I thought was “clean” may have in fact been exposing me to some new pathogen. So I glove up, always. Why take a risk?

On top of the gloves and lab coat, I sometimes wear a face shield or work behind a splash guard if I’m doing something that might cause splashes. Cutting open units of plasma and pouring them into a pooling vessel, for example. That gets messy, and I don’t need plasma in my eyes. I’ve also got big insulated gloves to wear when I handle specimens frozen in liquid nitrogen.

What’s the neatest/most unusual thing you ever found (if you can talk about it)?

I think it’s pretty incredible that in many cases, I was the first person to know that someone had influenza, or herpes, or leukemia. Until I called the doctor with the result, it was a suspicion. Afterwards, it was a diagnosis. That sort of thing kept me very aware of how important the work is.
 

Life as a Rural Med Tech

My friend and professional colleague, Scott, graduated with me from a medical laboratory technology program in Montreal several years ago. Our careers started very similarly, with both of us being offered positions in big Montreal hospitals. Last year, though, Scott made the decision to move to a tiny Quebec town so remote that there aren’t any roads connecting it to the big cities and you’ve got to arrive by plane or ferry. 
Because he believes strongly in the advocacy aspect of Medical Laboratory Professionals Week, Scott was happy to allow a chat to become an interview for my blog. He will be translating part of this post for use in his hospital’s newsletter to celebrate Lab Week in the far north.
Scott, you currently work in a very remote area of Quebec. Why did you decide to leave your job in a big Montreal hospital to work where you are now?

Changing from a larger institution to a more remote smaller institution was driven by the idea that I could be more involved globally in all the different branches of med lab. Larger institutions tend to train technologists in one particular area while a smaller lab involves more cross-training. Also, the quality of life in a small northern community was key in my decision to head north.
Downtown “Scottsville”
Besides the view and the shorter commute, what are the biggest differences you’ve noticed in how the lab is staffed and run at the two hospitals?

In the larger institution I found that quantity, tests per hour, turn around time were very important markers in the running of the lab. Patients are one of a number of patients. In a smaller lab; patient care and quality tends to be of the utmost importance. The results produced from a smaller lab are those of a neighbour, friend, or someone from one of the villages served.

I currently have three co workers. Two medical technologists and one technician. The shifts are 8am-4pm/10am-6pm/1pm-9pm Monday thru Friday with one 8am-4pm shift on Saturday and Sunday. All other hours are covered by an on-call service that is shared by the three medical technologists. Therefore, I do on-call every three weeks. I would say I’m called in on average 2-3 times per week. Emergencies most of the time are chest pains, heart attacks. Most big cases are transferred to larger tertiary centers. We are very dependent on charter airplanes: we have two planes on standby most of the time to move people around.

Scott’s winter transportation

Would you go back to a big hospital, now that you’ve seen what a small rural hospital lab is like?


It would be difficult to return to a larger institution. I am happy overall with the job in the smaller hospital. I think it has more to do with quality of life than the actual job. There are crappy things to working here and crappy things there. Right now there is less crap here than there. 🙂


The Montreal General Hospital

Do you feel like a bigger hospital, because of its volume, is less able to be careful? Are the results coming out of the lab more likely to be inaccurate?

Quality is a difficult thing to judge. I don’t think that results would be inaccurate but larger institutions with increased automation and being driven by quantity might have more difficulty picking up on problems that arise. Both institutions follow quality control and quality assurance guidelines; but to use an analogy, Ferrari produces very high quality cars but only produces a few per year while Ford produces millions of cars with very good quality but not to the standard of Ferrari.
“Scottsville”: Home to the Ferrari of hospitals

Speaking of automation, is the rural hospital equipped with older analyzers, or are you working with newer versions of the instruments?
 

Each institution chooses instruments based on needs. The larger institution had a higher volume and therefore required newer and more performing machines. The smaller hospital had instruments for the volume that is done and therefore they do tend to be a little older but still produce very good results. As an example, I saw a new instrument being offered by a biomedical company that could produce over 4000 test results per hour. In the smaller lab, an instrument of that size would be useless. The smaller institution requires more reliable, proven instrumentation.
He’s really, really far north

You’re in a very very out-of-the-way spot and depend on ferries to bring you supplies. Have you ever had problems getting reagents or blood for transfusion due to weather problems? What happens when an instrument fails and needs repair?

On a daily basis, we are very dependent on the weather. If the weather is bad, sometimes we cannot receive orders or send out specialized tests to other hospitals. We tend to check the weather on an almost hourly basis due to the rapid changes that can occur weather wise. One of the most important choices in my opinion for the lab when purchasing instruments in to purchase reliability. But in cases when things do fail, a med tech must be able to tinker with instruments with the assistance of over the phone tech support. We do carry a few spare parts but most are sent next day if needed. If an instrument has a major failure, service contracts guarantee that service technicians will come out and have a look. The smaller lab does allow me to get more hand on with repairs.
A ferry bringing food so Scott won’t have to eat his neighbors

What attracted you to the medical laboratory field?

I enjoy the scientific aspect of the job. I had gone to school in Chemistry and enjoy the idea of being more pratical than theoretical in the medical lab field.

Once you started work as a med tech, did the work resemble what you’d imagined it to be, or was it a shock to move from school to the work force?

The largest mental adjustment was probably dealing with stressful real life situations as compared to fictious cases. As medical technologist, we see the good and bad of most if not all health cases that pass through a hospital. The training I was provided in school provided both a classroom setting and a practical setting to help bridge the gap between theory and work life. Also, an internship in the last few months of school helped to limit the shock. Of course, in real life work, things are not always ideal and you’re always learning about new things, new ways, and improving yourself everyday.
Med lab reality can get pretty gross

If you could go back to a med tech program where students are just starting the basic classes, what would you say to them?

I would honestly ask them if they are truly dedicated to patient care. Are they willing to work odd hours, weird shifts, weekends, holidays? The lab, as any other health profession, involves thinking about others more than oneself at times. You have to be willing to be flexible and available because in the end it is to help someone in need.

Lab Week Link Roundup

It’s that time of year again, where the laboratory professionals emerge from their basement lairs and sniff the air hoping to detect the scent of muffins brought in by glassware vendors.
I write about my work often on this blog, and I especially enjoy highlighting my profession during National Medical Laboratory Professionals Week. It’s a profession that’s not well understood by most other healthcare employees, let alone the general public, and I feel that it’s important for me to educate more people about who laboratory professionals are and what they do.
I do have some new posts planned for Lab Week (April 22-26, so I guess the weekend techs get no respect this year, what’s up with THAT?), but because some folks might be coming here for the first time, I wanted to link back to some of my previous lab week posts so everyone has a chance to see them.
I’ve written about influenza testing, and how the doctor knows it’s the flu and not just a bad cold, and what doctors are looking for when they hand you a cup to pee into.
Someone asked me about all those different tubes they fill with blood when you go for a blood test, and so I wrote a little about the different tube types and what they’re used for. I took it a step further and explained what happens to the tubes once they get to a lab, getting into lab information systems and automation.
Because much of my lab career so far has been spent in the blood bank, I’ve also got a few posts out there about blood donation and what it’s like to see regular patients receiving that blood. For those interested in more of the science behind blood types and transfusion, I covered a little of that too.
Two years ago, I made a (very amateur) slide show detailing how important laboratory professionals are to the health care team, and what exactly it is we do all day. And night. And weekend. And holiday.
Not all lab work is hospital work – I will try to talk more about that this year, but for now, you can have a look at what my job in a manufacturing lab is like. 
I hope you enjoy reading a little about laboratory work. I like writing about my profession, and I’m never sure how much detail people want to see in my posts about it, so I’m always excited to have Lab Week come around to give me an excuse to geek out about it a little. There will be a few more posts up this week, so please come back!

Blood Donation During a Crisis

(Author’s note: this was written in 2013 after the Boston Marathon bombing, and it’s incredibly depressing just how often I come back to this post to share it after tragedies)

As is our human nature when faced with violent acts, people reacted with horror, sympathy, and an aura of nervous energy after the Boston Marathon bombing. Whenever there’s a tragic event, whether it’s a bomb, a plane crash, or a tornado, most of us feel like we should do something to help those affected. Even if we’re far away, even if we’re not directly connected to anyone who was hurt, there’s this spark of humanity inside us that drives us to action.

It’s crucial to note, though, that not all helpful actions are necessary, and not all good actions are immediately helpful.

Many people in my Twitter feed were urging people to go and donate blood. I am an occasional blood donor. I encourage people to be regular – for their own personal definition of “regular” – donors. But this week, when I saw the flood of “go give blood” tweets, I cautioned against rushing to the donor centers.

Why? People were horribly injured and being rushed to hospitals for surgery. Didn’t they need blood?

Yes, many of them likely did. But the hospitals were prepared. Every hospital has a plan in place to help them deal immediately with an “external disaster.” They keep a good supply of blood on their shelves, and they have means to get more very quickly.

An organization like the American Red Cross* can move blood products efficiently from one area of the country to another. It happens every day, even in calm and peaceful times, but in an emergency, the wheels turn very quickly to get blood products to where they are needed as fast as possible.There seems to be an almost-constant “blood shortage” going on, so it does seem confusing when Red Cross officials tell people not to come in right now and donate. What’s important to understand is that the key to having enough blood available for a crisis is to have an adequate blood supply at all times. That’s why the Red Cross encourages regular donations: the need is constant.

So why isn’t more blood better? Why is the Red Cross of Eastern MA asking people to please wait and come in next week if they want to donate blood?The thing about blood is that if you go to the donor center right now and roll up your sleeve, and have a unit taken from your veins, that blood will not be used immediately. It needs to be tested for HIV, Hepatitis B and C, West Nile Virus, and all sorts of other things. There’s a two-day turnaround for blood products. Donating blood during a crisis isn’t necessarily going to help the victims of that particular crisis. The Red Cross will do its best to accommodate all the generous donors inspired by the tragedy, but there’s a risk involved with a huge rush of donors at one time. Blood is perishable. Units of blood get a 21-to-42-day expiration date. So what happens a month after the crisis, when everyone’s just donated but all the blood is about to expire? Nobody wants to see blood wasted.

And that’s why I urged people to wait and see whether there was a need before rushing to donate. Replenish the supply by donating a little later, so that there’s always blood available for everyone who needs it.

What can you do to help when disaster strikes, then, if you shouldn’t give blood?

  1. Don’t misunderstand me! Do donate blood. Please do. It saves lives and nobody would argue otherwise. But don’t rush in after a disaster. Wait. See if the American Red Cross puts out a call for donors. If there is no immediate need, make an appointment a week in the future, or two weeks. Give often. Help keep the supply constant so hospitals can do their thing when they need to.
  2. Follow @RedCross on Twitter or like them on Facebook. When something is happening, those accounts are very active and are an excellent source of news and support. There are accounts and pages for local Red Cross areas, as well. They will tell you how you can help.
  3. Learn CPR and first aid. If you’re ever in a position to give more direct help to someone injured in an accident or attack, you will be more confident and better equipped to act.

*I use the American Red Cross in my examples because I have a familiarity with their processes thanks to my work experience, and because they are a very important blood supplier for much of the United States. I don’t claim to speak for them in any official matter.




In My Blood

In most other workplaces, a blood-spattered desk would be cause for a police investigation.

For me, it was just Friday.

Let’s just say that if blood or other bodily fluids and excretions bother you, you probably don’t want to pursue a career as a medical laboratory scientist.

But maybe you do want to pursue that path. Maybe you love medical science but aren’t masochistic enough to put yourself through medical school. Maybe you love helping sick people but don’t want to be anywhere near them while you do, because, frankly, they’re a little needy. Maybe you love biology and lab work, but don’t want to spend a lifetime begging for grant money to keep your cell cultures or graduate students fed. There’s hope for you yet! Stay tuned to find out how you too can have a vibrant healthcare career!

I know, that’s a ridiculous infomercial, but I feel like it’s my duty to promote my profession, because there are too few of us out there. We’re not well understood or respected. I want that to change. Everyone knows about doctors and nurses, but the third vital side of the healthcare triangle, the medical “techs”, live in relative obscurity.

The Board of Certification for medical technologists here in the US changed things up a couple of years ago and tried to give us more respect by changing our title from “Medical Technologist” to “Medical Laboratory Scientist”. It was a lovely gesture, but it didn’t really help. I mean, I didn’t get a raise or a talk show or anything, and I still get a blank stare and polite nod when I tell folks what I do. Although I think people picture a lab coat and some test tubes now, which is a little closer to right.

I write about my work sometimes on this blog, and last year, I wrote a series of posts here for Medical Laboratory Professionals Week. Some of them explain the science and techniques behind laboratory tests, and some of them are about my experiences in the various labs I’ve worked in. I would very much like to do that again this year as a way to raise awareness about the profession. I never heard about medical laboratory science careers until I was already through university with a Bachelors in Physiology and couldn’t find much to do with it. I hope that by writing about it here, I can make the profession just a little more visible, and maybe inspire someone to look into it as a career.

Even if I can’t inspire anyone to get into a lab career, maybe I can help people understand what the job is about. Why do you only have to fast sometimes before a blood test? What happens to a blood donation? How does blood tell the doctor how sick someone is? I’d love to make Medical Laboratory Professionals Week into a sort of Q&A session, but for that I will need your help. Does anyone have any Qs that I can A?

What do you think the job is? Have you ever heard of it before? What would you like to know about labs, blood, and medical tests? I’m getting started early this year because I want to collect questions and get to work answering them well. I want to give myself time to draw diagrams and take pictures and maybe even interview folks in different types of lab positions, so I can really do right by my profession and show off my colleagues as the caring, intelligent, dedicated people they are.

So, hit me with your questions, and I’ll do my best.