Tag Archives: laboratory

Nine Exciting Part-Time Jobs for Med Techs

Whether you’re calling yourself a medical laboratory technologist or clinical laboratory scientist or any combination of those, let’s face it: you’re likely underpaid, overworked, and underappreciated by the rest of the healthcare team. In honor of Medical Laboratory Professionals Week, April 24-30, 2016, I’ve come up with a helpful list of part-time jobs that med techs can sign up for on their days off to bring in a little extra money. After all, we’ve got an impressive skill set thanks to our laboratory training!


1. Large Appliance Mechanic

maintenance on beckman lab instruments

The instruments are always down, and you’re always neck-deep inside one trying to figure out what’s stuck where. Why restrict yourself to chemistry analyzers and hematology counters when those same skills can probably dislodge stray forks from a dishwasher?

2. Shelf Stocker

shelf full of laboratory reagents

Everything is labeled, facing front, tagged with expiration dates and segregated by lot number. The grocery store will never be the same once you’re done with them.

3. Flower Arranger

plastic beaker full of pipettes

You can fit one more carnation in there. And a fern. Keep jamming.

4. Crime Scene Cleanup Technician

blood cleanup with bleach

It’s disturbing how quickly you can jump in with advice when someone asks how to get blood out of clothes.

 


5. Balloon Artist

balloon made of nitrile glove

They work well as water balloons too. Don’t ask me how I know. What happens during lab week stays in lab week.

6. Extremely Patient Phone Customer Service Representative

lab phone call

Yes, your specimen is hemolyzed. No, it was definitely like that when we got it. And no, we can’t run it anyway. No, we don’t hemolyze it just because we don’t like you. We’d use those laser-eyes for much better things if we had them, trust us.

7. Timekeeper

laboratory timers

Bake cookies in four different ovens. Sit in a hairdresser’s and monitor how long the dye’s been on whom. Stand by the track at the Olympics and time the bobsleds.1

8. Barista for Blood Cafe

pouring blood

Depending on whose blood you’ve got, it’s pretty lowfat, and I can definitely give you extra foam.

9. That Guy Who Writes Names On Grains Of Rice

labeled tubes sharpie

We know that anything fatter than an ultra-fine Sharpie doesn’t deserve the pocket space. Years of teeny tiny writing on tubes, labels, and badly-designed downtime worksheets means that we’ve perfected the skill of fitting our initials and the date (and more) into microscopic spaces.


Happy Lab Week to all my fellow lab rats. May your QC always be in range and may your STATs be few.


1 True story: I bought myself a lab-style timer for my kitchen, because I’m so well-conditioned that I can’t help but respond immediately to the beeping. And multiple channels are so incredibly useful when I’m cooking and have one thing on the stovetop and one in the oven and need to keep track of them both.

Many thanks to my lab friends for helping me with the photos for this post.

Amazon links in this post are affiliate links, and you can read more about that here. I only ever link to products I love and recommend.

Re-Engineering

It’s never a good day when you’re called into a conference room and find a Human Resources representative sitting at the head of the conference table with a slim folder in her hands and an emotionless expression on her face.

The organization I work for is making cuts. Lots of them. We’re being re-engineered, re-shuffled, made leaner and meaner and more competitive. And unfortunately, the executive vision of the organization’s bright future only includes 3/5ths of my job. I guess I’m grateful that they didn’t do away with my position entirely, like they’ve done to so many others, but that’s a whole lot less money I’m bringing home to my family.

I refused the severance package and stayed on part-time, for now, despite the obscene increase in my health premiums now that I’m only working 24 hours a week. So obscene that you should probably stop reading this if you’re at work. My cost tripled. That is multiplied by three. Double it, and then add a bunch more. Yay, US health insurance system. So I’m working for benefits, essentially. But I have a job, we have health care, and it could be worse.

I’m using my not-at-work days* to write and get housework done so maybe I’ll be freer in the evenings and on the weekends to just hang out with my family. Theoretically, part-time work is great. The mom thing is a ton of work and it would be lovely to have a regular day or two during the week that I could dedicate to the job of parenting.  Our daycare doesn’t have a part-time option, so kiddo is still there all week – no savings there. But that does mean that I’m able to handle errands and appointments and cleaning without a baby underfoot. And I could easily pull him out of class early on days I’d like to do special activities with him. I was able to enjoy the Halloween parade there this morning, and stay for a couple of hours to get him into his costume, walk him around to see the decorations, and take a million photos.

Financially, though, part-time work sucks. A lot. Lots of people are infinitely worse off, and I’m not going to complain too loud, but this means fewer nice things, fewer house projects, fewer vacations. And more importantly than all that, I get a sense of worth from my work, and being cut really hurt. I need to work, and it would be wonderful if I could work somewhere I felt I was making a difference somehow, and growing as a person.

I’m not sure I want to go back to the hospital labs, working weekends and holidays and being stuck there if the next shift is late, because the blood bank never closes. Besides that, the hospitals are far, and I’m so tired of long commutes. There are research labs around, too, and I’m looking into those, but I’m starting to wonder if it isn’t time to re-engineer myself a little. Who am I, who do I want to be, and how do I get from here to there? Do I need to cut any of my efforts by 2/5ths in order to move forward?

I read Wil Wheaton’s post about “rebooting” his life this week, and it’s still bouncing around in my head. Reboot. Re-engineer. What better time for personal change than a time when everything’s changing around me anyway? What can I fix? What can I focus?

Well, I know I want to write more. So I’ll write more. And read more, too, because Wil’s right that input is necessary for good output. I have a very long reading list to get to, and maybe being part-time for a while will give me time to make a dent in it. I’ve also got more time for writing now, which is great because I’ve got a couple of paid gigs these days, on top of my volunteer projects, guest posts, and this blog. Maybe it’s time to look into doing this more seriously. Am I good enough? Can I get good enough?

*Don’t you dare call them my days off. This isn’t a vacation, it’s 2/5ths unemployment.

Lab Q&A – I could really use your Qs!

I’m live-tweeting my workday today, and it’s probably the most entertaining thing I’ve done in ages. I should have done this for Lab Week!

The response is reminding me how much I love talking about laboratory science, and how important it is to share a little bit of it with the world, so my profession can be better understood.

But I’m not a professor with a lesson plan, and what’s fascinating to me may bore others to tears. So I need to know what you’d like to know about what goes on in a laboratory. I worked in hospital labs for several years, and now I work in a blood reagent manufacturing lab, so I’ve got a whole bunch of answers rolling around in my head – I just need you to prompt me with some questions.

So, folks: what have you got?

Professionalism

A friend recently pointed me to this article about the professional responsibility and ethics that come into play when a healthcare professional is faced with treating a patient in a way that goes against their own beliefs. Since I’m a member of one of those professions, I thought I’d share my perspective.

When you commit yourself to a healthcare career, you don’t have much control over what kinds of patients you will see. Yes, a doctor can choose to specialize in obstetrics or urology, and a nurse can choose to work at a retirement home because he or she doesn’t like dealing with children. But you don’t get to decide what kind of care your patients will get based on their politics, their religion, or their life choices. You can encourage a patient to quit smoking, but you can’t give someone subpar care for their emphysema even if you feel, deep inside, that they brought it upon themselves.

Doctors take an oath to do no harm, and while I don’t know if others in the healthcare professions do the same, I can say that the overwhelming majority of those I’ve known in those positions take immense pride in their work and treat all patients with great care and respect. Those who triage their patients by anything other than medical urgency quickly lose the respect of their peers. Or they lose their jobs.

That’s why it bothers me when I read things like this, from Twitter right after the Boston Marathon suspect was taken to the hospital:

Now that the 2nd suspect is caught and in the hospital, what’s preventing a Doctor/Nurse from injecting “go fuck yourself” serum?

Frankly, the very concept is offensive to me, and I think I speak for the vast majority of medical and allied health professionals. Of course the medical team isn’t going to enjoy some vigilante justice and “accidentally” give him the wrong care to watch him die. And that’s not just because so many people are watching, or because the police have instructed them to keep him alive. It’s their job to keep him alive. Every single person who comes through those doors will be given 100% of their effort, because that’s how a trauma emergency room works. It doesn’t matter if you’re a four-year-old who was hit by a car, or the drunk driver who hit him. You’re a broken body, and they will do everything they can to put you back together.

I had a colleague who once told me that the lab he worked in years ago used to receive and test specimens from smaller medical facilities every day, because the smaller places didn’t have labs of their own. When he found out that one of them was an abortion clinic, he refused to have anything to do with those specimens, saying that running the tests would go against his religious beliefs. He’d have had nothing at all to do with the actual abortion process, mind you. The specimens he would have been testing would have been for the women’s blood counts and chemistries: tests no different from what you’d have done at your annual physical. Astonishingly, his coworkers and employer had no problem with his decision, and accommodated him. I couldn’t help but wonder what would happen at our current employer if he was faced with a similar situation. We didn’t deal with abortion clinics, but we did have several operating rooms and sometimes there were D&C’s on the operating schedule – with no way to know whether they were being done after miscarriages or planned abortions, would he refuse to crossmatch blood for those patients if they hemorrhaged on the table? To be fair, I never saw him refuse any specimen while I worked with him, so maybe his attitudes had changed by then. I didn’t probe further, because an ideological debate has a right time and a right place, and an evening shift in a busy laboratory is neither of those things.

The fact remains, though, that he did refuse care to patients based on a conflict between their decisions and his religious beliefs. It wasn’t direct care, it wasn’t emergency life-saving care, but it was still a massive breach of professionalism. And he got away with it. No disciplinary action, no reminder that a patient is a patient and a test is a test and you don’t get to choose like that.

I’m equally appalled by pharmacists who refuse to dispense the legal, FDA-approved Plan B contraceptive pill despite the patient’s valid prescription. Like my former coworker, they get away with it. As long as someone else can fill the prescription, they can keep their conscience clean. And I think that’s bullshit. Pure, unadulterated bullshit. Your obligation as a pharmacist is to dispense medications to patients. You don’t get to decide not to give out Plan B because you’re opposed to the idea, just like you can’t refuse someone their diabetes pills because you think they should be exercising more and eating better, and you don’t want to be an enabler. If you want to be a pharmacist and you want to avoid ever having to give out contraceptives, go work in hospice care or geriatrics.

It’s simple. You have an obligation, when you work in health care, to do your absolute best for each and every patient you interact with. If you’re not able and willing to do that, because your personal beliefs get in the way, then you need to find a new job.

 

What else can I do with my medical laboratory degree?

To close out this year’s edition of National Medical Laboratory Professionals Week, I want to step away from the hospital lab.
I left the hospital life a year and a half ago to move into an entirely different sort of laboratory work, but I still talk about the hospital every time I’m asked questions about the profession. I do it because it’s the world I worked in the longest (so far) and so I know it very well, and because the majority of graduates from medical laboratory science programs will find employment in hospital labs. My information about working as a hospital med tech is relevant and well informed, but it’s not the entire picture.
You can do a lot more than hospital work with a MLT or MLS degree. There are also positions available in walk-in medical clinics like LabCorp or Quest, and in some large medical practices. Some specialty medical practices, like endocrinology centers and fertility clinics, will also have their own small laboratory in-house to run some of the simpler tests. Often, in those places, a lab tech will end up doing more outside-the-lab work, like bringing patients into exam rooms, and taking blood pressure and other vital signs. Some of them are 24-hour places with shift work, and some are a 9-to-5 weekday job.
There are specialty laboratories that run all the weird complicated testing that other labs aren’t equipped to do, like genetic testing. There are veterinary labs. Most manufacturers of food, cosmetics, and drugs will have laboratory staff to test their products for quality. There are labs that specialize in drug testing, for pre-employment screens or for athletes.
Depending on your interests, you can get yourself into a research laboratory at a university, or a place like NIH or the CDC. There are plenty of laboratories at the county, state, and federal level, also. Public health labs are the most obvious ones, but what about the FDA? EPA? Even the U.S. Geological Survey does a ton of microbiological research.
You can teach. You can travel and be a tech in other countries. You can get more technical and work for the instrumentation giants like Beckman Coulter or Siemens, either in tech support, sales, or research and development of new assays. If you like computers, you can get into programming and work with laboratory information systems.
And working for these companies doesn’t necessarily mean you need to be sitting at a lab bench. Someone who’s got a laboratory background can do very well in tech support, customer service and education, quality assurance, or regulatory compliance.
That’s another area lab techs can move into – there are several regulatory bodies who oversee laboratories of different types. The American Association of Blood Banks, The Joint Commission, The College of American Pathologists – all of these organizations inspect laboratories for compliance and hand out accreditation, and need inspectors who understand laboratories.
Yes, when you graduate from a medical laboratory science program, you’ll probably start out in a hospital lab, doing the shifts that the seasoned techs don’t want. But you’re not stuck there if you don’t like it. It’s been my experience that the school programs aren’t very good at showing students all the other options that are out there, and how they can work towards them. Hopefully this post helps a few folks who are hating their night shift hematology job but don’t know what else they can do with a medical laboratory degree.

Are There Any Questions? (Part 2)

How did you decide to enter this field?
I had a Bachelor’s degree in Physiology and didn’t get into graduate school on my first try, mostly because of a lack of practical research experience. I decided that the MedTech program would be a good way to earn some practical laboratory skills while I waited a year or two to apply again. I was surprised at how much I enjoyed the course material, though, and I ended up staying with the program and finding rewarding work in a hospital lab.

What kind of education and training did you have?

I already had a Bachelor’s degree, and the MedTech program I graduated from was in a “CEGEP” in Montreal, which is similar to a US community college. While it was only a 3-year program, the Canadian Society for Medical Laboratory Scence (CSMLS) considers it equivalent to the 4-year college laboratory programs in other provinces. When I wanted to work in the US, my MedTech degree would have only been sufficient to let me sit for the MLT exam (Medical Laboratory Technician), but with my previous B.Sc. I could write the MLS exam and be a Medical Laboratory Scientist.

The final 6 months of that program were an unpaid internship shared between three area hospitals, where I worked 8-hour shifts in all the areas of the lab: hematology, biochemistry, blood bank, microbiology, and histotechnology. During that time, I got to work as though I were one of the hospital’s regular employees, running patient specimens and reporting results. I was supervised and guided, of course, but after the first few days of training, I was mostly on my own and dealing with the workload as though I worked there for real.

What personal qualities are important for an individual considering this field?

Attention to detail is crucial, and an ability to detect when something doesn’t seem right is a big plus. Sometimes a result might seem okay but in context it won’t make sense – a good tech can sniff those out and deliver better care. For example, a really high glucose level might mean a diabetic patient in a crisis, but it could also mean that the specimen was drawn from the same vein a glucose IV is connected to.

Multitasking well is also helpful, because you’re rarely just doing one thing. Most of the time, the laboratory staff is cross-trained to some extent, so that the tech running the urinalysis bench can go help the hematology tech if the workload is uneven. Especially on the off-shifts, where that type of “generalist” is much more common, you need to be willing and ready to be a team player. I know that gets thrown around a lot in the business world, but I think it’s very true in the laboratory and I don’t mean it in a dismissive corporate-speak way. The tests must get done, or patient care suffers. So if someone’s getting backed up in their workload and you’ve got nothing to do, you get up, go over, and help. It’s just what you do in the lab, because you care about those patients waiting for their results.

What do you wish you had known before entering this field?

The profession, while as vitally important to patient care as nursing, doesn’t get very much respect. Few people know we even exist, let alone what we do, and our pay is much less than for nurses with equivalent education and experience. Unfortunately, this ignorance of our importance can sometimes exist within hospital management, and labs are often understaffed and overworked, with old equipment that can’t be replaced due to budget cuts. We make do and we put up with it because we care about the patients upstairs in the OR or the ER or the maternity ward and want to do right by them.

That’s why I care so much about Lab Week – I want to advocate for the profession so that we’re more visible and our work is better understood. Without dedicated and caring laboratory staff, a hospital would fall apart.

What do you like best and find most rewarding about the career?

Knowing that every day, I did something to help a patient live longer or healthier by providing a doctor with a result, or preparing blood products for transfusion.

Now that I’m out of hospital work, I find I’m enjoying learning more about quality assurance as it applies to the laboratory. I’m doing more research and development work, and manufacturing FDA-licensed test reagents, and it’s a lot slower-paced than when I was used to in the hospital. I like that I’m getting a chance to learn so many new things right now.

What do you like least and find most frustrating about the career?

Hospital politics and understaffing. It’s hard to do a good and safe job when you’re working on too many things at once.

How much influence do you have over decisions that affect you?

That depends on the specific lab and on the manager and supervisors. Good labs will ask for input before changing schedules, ordering new equipment, and adopting new procedures. In my experience, I have not had enough influence. That’s part of why I took a break from hospital work (but being tired of evening shift was the main reason). I’ve never been very good at accepting “because that’s how we’ve always done it” as an answer, and that sometimes gets me into trouble. I’m a problem-solver by nature, and I’ve always tried to improve processes by studying them first instead of just applying random fixes. While I think that hospital labs are starting to head in that direction, there’s still a long way to go, and I often found myself frustrated when hospital management decided to “solve” a problem without really understanding it.

What additional training and qualifications are necessary for advancement?

There are levels of certification. MLT and MLS are the most common ones, but you can also take special courses for advanced certification in one specialty like chemistry or blood bank, and that is often a good path towards management. It’s also possible to branch out from the hospital lab and work in other fields like quality assurance, manufacturing, instrumentation, and IT.

What specific advice would you give to someone entering this field?

Don’t cut corners, ever. You have lives in your hands. Quality control is done for a reason. Procedures are in place for a reason. Don’t ever let anyone else (nurses, doctors, management) bully you into cutting corners, either. Be prepared to work hard and probably not get a ton of kudos for it. I enjoyed the satisfaction of knowing the difference I was making, and I enjoyed the pressure and the feeling of being needed. It can be an incredibly draining career, but worth it if you want to be in healthcare and prefer working in a lab instead of directly with people. Oh, and if you’re easily grossed out, or if you tend to faint at the sight of blood, this is obviously not a career for you.

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.

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.

Q&A – Color coded blood collection tubes

You go to the doctor, and they order some blood tests to see what’s going on inside you. You sit down with a phlebotomist to get some blood drawn, and a week later you get results back, but what happens in between? I hope that I do a good job explaining things – please let me know in the comments if there’s anything I missed or that you’d like to know more about.

The question for today is:

Are the colors of caps consistent across labs? I seriously always just figured it was an internal thing, and the bar codes on the sides were the important parts of communicating info to other labs if blood had to be sent out there.

I’m going to break this into two parts, about tube colors and bar codes, and address each one in a separate post. I’ll start with the colors.

If you’ve ever had lab work drawn, whether at a doctor’s office, a hospital, or an external collection site like LabCorp, you may have noticed that when they take more than one tube of blood, the caps on the tubes are usually different colors. That’s because there are different requirements for how the blood is treated and transported before it gets tested.

 

blood collection tubes

Blood collection tubes via Flickr under CC license

Cap color is indeed consistent across labs. More accurately, you could say that it’s consistent among the major manufacturers of blood collection tubes. It’s possible that the manufacturers are doing this voluntarily, but I suspect there may be a federal entity like the Food and Drug Administration (FDA) involved, since it could hugely affect patient safety. Even if there is no official rule about cap color in the Code of Federal Regulations, I suspect that someone trying to market an EDTA tube with a green cap would find a very grumpy FDA inspector on their case.

Color coding the blood collection tubes means that blood will always be collected and tested properly for every type of blood test, no matter where it’s drawn and what lab it’s sent to for testing.

 

Now, I know that EDTA (ethylenediaminetetraacetic acid) probably doesn’t mean much to you, yet. I’m here to tell you that it’s an anticoagulant, one of many, used in blood collection tubes. Depending on what test is being run, we want the blood in the tubes to act in different ways. I’ll go over the most commonly used tubes and explain what the cap colors mean and what sort of tests each type is normally used for.

 

Pink or Lavender – EDTA

EDTA tube – from bd.com

 

Both pink and lavender tubes contain EDTA, which is a chemical that binds with and ties up calcium ions. Because blood needs calcium ions present in order to initiate the clotting process, blood that is collected into a pink or lavender top tube (and well mixed) will remain liquid.

Lavender tubes are generally used for complete blood counts (often shortened to CBC), which includes things like white cell and platelet count, and hemoglobin. This makes sense – if we’re trying to do a platelet count, we need the blood to remain liquid, since a clot is going to tie up a bunch of platelets. If a number of blood cells are tied up in a clot and unavailable for the instrument to count, then the count will seem a lot lower than it really is. A CBC is one of the most commonly ordered tests, because it can tell a doctor about infection (high white cell count) or anemia (low red cell count), which are common reasons for doctor visits. You’re very likely to have a lavender tube drawn if you’re getting lab work done.

The main difference between the two colors is that the pink top tubes are generally bigger, and get spun down in a centrifuge to separate the plasma from the cells. The pink tubes are primarily used in the blood bank, because we run tests on both the cell part and the plasma part of the blood. We could use lavender top tubes, but we like to have a bigger volume of specimen to work with, in case we need to start cross-matching blood for the patient, which will use up the plasma. Also, the rules for labeling blood bank specimens are usually more strict, and having a bigger tube leaves more room to write out the patient’s information.

 

Light Blue – Sodium Citrate

Sodium Citrate tubes – from bd.com

Blue top tubes are used primarily in coagulation studies, like monitoring heparin or warfarin therapy, or looking for clotting disorders before a patient goes to surgery. Sodium citrate, like EDTA, also prevents clotting by tying up calcium ions, but it’s better than EDTA in preserving the rest of the blood’s clotting factors. The tubes are always the same size, and contain a set amount of sodium citrate. Most coagulation tests start by adding some calcium back in and seeing how long it takes for the blood to clot, so it’s extremely important to fill the tubes all the way. An underfilled tube will have an excess of sodium citrate, which will tie up some of the calcium the instrument is adding in, which will make it look like the blood’s taking a very long time to clot. If you aren’t on blood thinners, and you’re not showing signs of a clotting disorder, you aren’t likely to see the phlebotomist pull out a blue tube.




 

Light Green – Heparin

Heparin tube with gel separator – from bd.com

These were the most commonly used tubes in the chemistry section of the hospital lab. They’re used for glucose (blood sugar) testing, electrolytes like sodium and potassium, and other important analytes like cholesterol, liver enzymes, and cardiac markers that can indicate a heart attack. This anticoagulant is usually a Lithium-Heparin salt, instead of a potassium or sodium salt, because most basic metabolic profiles (you’ll sometimes hear them called a Chem-7 or Chem-some-other-number on TV medical shows) will measure potassium and sodium, and we don’t want to falsely increase those numbers with our anticoagulant. We also can’t use EDTA, because the calcium would look too low.

Because chemistry testing is focused on the plasma, the blood is centrifuged to get the cells out of the way. Some tubes go an extra step with a built-in gel barrier, which keeps the cell portion trapped below so that even if you invert the tube, the cells stay put. This makes it easier to aliquot the sample (take small volumes from the main tube for other testing) without disturbing the cells and making it necessary to spin the tube again.

 

Gold – Gel Separator, No Additives

Gold tube, no additive – from bd.com

In situations where it’s okay for the blood to be clotted, a gold top tube can be used. It has no anticoagulant, so after the blood has been in the tube for a few minutes, it will form a nearly solid clot. Once spun, the tube will have cells and serum separated by a gel barrier, which makes it easy to pour the serum off into other tubes for separate tests. These tubes are often used when the serum is to be sent to an outside lab for special testing (anything not done at the lab where it’s drawn), because it’s easier to pour the serum into transport tubes for refrigeration or freezing, and they’re a little cheaper because they have no additives.

Many labs use these as their workhorse tubes, accepting them instead of heparin tubes for chemistry workups. I don’t actually know why the lab I was working in used the green tubes for most of the chemistry – a lot depends on the instruments being used in the lab and whether they have specifications for the test material. If your test’s instructions say it needs to be a heparin tube, then that’s what you should use, because the results may not be reliable if you use something else. Also, it’s better for the patient if we can run several tests off of one tube, and not just to keep costs down. Repeated blood draws can lead to bruising, and if excessive, to phlebotomy-induced anemia. So, if you can choose to use either a green or a gold tube for a certain test, because both are allowed by the instrument’s specifications, but another important test in the lab needs to be on a green top, it may make sense to bundle those tests together onto one tube.




Other – Special Cases

Some other colors are out there, but they’re used infrequently and you’re not likely to see them unless you’re having fairly rare tests done. In our lab, dark blue tubes were used detection of heavy metals like copper or lead, because the tubes and interior of the caps were free of trace metals. Red top tubes had no additives, like the gold tubes, but contained no gel separator, so they could be used for some therapeutic drug levels – the gel has a tendency to absorb some drugs over time, so a red top would be more accurate in those cases. Gray tubes were used for lactic acid levels, but some places use them for glucose, because the potassium oxalate anticoagulant in the tubes stops the red cells from using it all up.

While different labs will use the same tubes for different tests, depending on their methodologies, a lavender top tube in one hospital will contain the same additives as one in any doctor’s office. It’s common sense, really – you don’t want a part-time employee who works at two different facilities to get confused and use the wrong tube for a specimen collection, because it’s what he’s used to at the other job. Yes, it gets looked at in the lab, but we’re all human and sometimes a wrong tube can go on an instrument, and since all the instrument does is read a bar code and perform the tests it’s instructed to, you’ll still get a result, and it may be very wrong. Consistency is key to medical and laboratory safety.