Dear Stephen/Ian - Yes that is right.
The issue, as you suggest is the capability to do
the job, but also relevant is that of willingness
to take responsibility.
I could (in theory) perform an appendicectomy with
a histopathology MLA but we would undoubtedly be
sued if we got it wrong.
If it is simply a matter of rote adherence to
guidelines, then there is no responsibility to be
taken, no decision making, no art of medicine -
and not really medicine at all (something closer
to NHS direct) - If that is what we are talking
about devolving, then why bother?
Anything can be devolved, but if we are talking
about devolving of rote guidelines, they may as
well be devolved to a computer -- or of more
relevance - to patients themselves - to self
prescribe under most circumstances, understand the
science (which most can), question that science
(are we doing that) and obey the rote rules
themselves.
However there is another problem - As a Chemical
Pathologist, I would like to apply for a Clinical
Scientist post and accept a salary cut. I am as
qualified or more qualified than most (PhD,
FRCPath, MSc, BSc...) and have far more extensive
bench experience than the majority. I assume that
I will and should encounter no barriers. You
should ask me what happened when I tried to get
registered on the European Clinical Scientist
Register some years back.
On a serious note, many Clinicians are not taking
responsibility anyway, and are simply prescribing
according to guidelines, accepting corrupted
science at face value, and ignoring the reality of
the patient in front of them. We are failing to
question guidelines even in the face of overt
evidence that they are a crock of crud. The mute
silence of our profession over widespread fraud
and misconduct in drug trials shows a certain lack
of responsibility (SSRI's, Ezetemibe, Vioxx,
Avandia, trasylol ...... anyone read JAMA
recently?). So perhaps the thing could and should
be devolved. The chief grounds could be that we
are not doing our jobs (practicing medical
science) so others might as well not do our jobs
as well.
In terms of doing jobs - we no longer seem to have
any plausible reference ranges (in contrast to 20
years ago) for many things. We are not exploring
and hardly understand in detail the laboratory
things we used to explore many years ago
(biological variability, analyte stability,
clinical utility of the tests we use), so perhaps
there are jobs to be done closer to home that
require dedicated and caring laboratory people.
Someone ask me about the origin of the CE mark on
a certain kit we use, or why much of the science
of the bone resorption marker NTX can be thrown
down the toilet. In fact a lot of the work
involving the bone marker serum CTX can also be
put in a similar place because no one bothered to
look at the stability of the analyte.
Aubrey
FS>
FS>
FS>
FS> Ian
FS>
FS>
FS>
FS> I agree - why not? IMHO well done for raising
FS> an issue when you should have expected some
FS> heavy incoming as a result: some friendly fire
FS> and some not quite so friendly. Even though
FS> this is supposed to be a discussion forum I
FS> suspect many are wisely keeping down their heads. So here goes...
FS>
FS>
FS>
FS> There is nothing like a good demarcation
FS> issue to generate a bit of heat. I remember
FS> sitting through a very interesting local
FS> staff-side 'discussion' between NHS painters
FS> and electricians as to which was most skilled,
FS> and by implication which group should be paid most.
FS>
FS>
FS>
FS> If Clinical Scientists prescribed there are
FS> issues about competence and training that
FS> would need to be address and it wouldn't be
FS> suitable for all of us (I would certainly need
FS> some training but who doesn't!).
FS>
FS>
FS>
FS> Can I stir things up more and reflect that
FS> one difference between clinical scientists and
FS> the other professions nationally is we lack
FS> the advocacy of a single profession
FS> association: compared with doctors, BMSs,
FS> pharmacists, nurses, dieticians, therapists and so on.
FS>
FS>
FS>
FS> Secondly I have noticed we are as a group
FS> uniquely polite to other professions while
FS> they say what they like about us
FS>
FS>
FS> By the way I have also heard other medical
FS> physicians say they should do the lipid
FS> clinics as they have a wider general medical
FS> experience than Chemical Pathologists.
FS>
FS> Best regards to all
FS>
FS> Steve
FS>
FS> (Clinical Scientist)
FS>
FS> ________________________________________________________
FS>
FS>
FS>
FS>
FS>
FS> Views expressed are my own and not
FS> necessarily those of the Trust.
FS>
FS>
FS>
FS>
FS> -----Original Message-----
FS> From: Ian Barlow [mailto:[log in to unmask]]
FS> Sent: 23 April 2008 15:01
FS> To: [log in to unmask]
FS> Subject: Re: Clinical Scientist Prescribing (was Lipid Clinics)
FS>
FS>
FS>
FS>
FS> Thank you David for your input, but
FS> increasingly, like it or not, professional
FS> boundaries are being broken down and are becoming very blurred.
FS>
FS>
FS>
FS> If Nurses, Pharmacists, Dieticians etc etc
FS> are encouraged/developed (after appropriate
FS> training) to hold clinics then why not Clinical Scientists?
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> You state:-
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> "I have a far greater sense of unease at the
FS> prospect of scientists trying to muscle in on
FS> clinical work. Unfortunately, there seems to
FS> be a trend with people thinking they are above
FS> doing more traditional aspects of their jobs
FS> and seeking to cadge bits from other people so
FS> as to appear more important and get better paid"
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> - just to clarify my position - I have been
FS> approached by one of my cardiologists as to
FS> whether I would consider doing joint lipid
FS> clinics with him. Therefore this is not about
FS> "cadging bits from other people so as to
FS> appear more important and get a better paid job".
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> Best wishes
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> Ian
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> -----Original Message-----[Ian Barlow]
FS> From: Clinical biochemistry discussion list
FS> [mailto:[log in to unmask]]On Behalf Of David Hardy
FS> Sent: 23 April 2008 13:10
FS> To: [log in to unmask]
FS> Subject: Clinical Scientist Prescribing (was Lipid Clinics)
FS>
FS>
FS> No, sorry, I firmly believe in horses for courses.
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> Those of us that work (or have worked) in
FS> laboratory medicine know only too well what
FS> can happen to (say) a blood gas machine
FS> when junior medical staff get at it, even
FS> after they have had appropriate training. They
FS> may be doing the testing, but they do not have
FS> the background training in analytical science
FS> to appreciate all the pitfalls. And why should
FS> they? They are employed to treat the patients
FS> and we hope they have an appropriate
FS> understanding of what is involved in that to
FS> do a good job. Scientists (all flavours) are
FS> there to do the science, keep the service
FS> running and guide the clinicians in these
FS> specialist areas. I have always felt a sense
FS> of unease in devolving testing to those whose
FS> training is not in clinical/biomedical
FS> science. I have a far greater sense of unease
FS> at the prospect of scientists trying to muscle in on clinical work.
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> The training of a clinical
FS> biochemist naturally concentrates on the
FS> science - there is enough medicine covered to
FS> make for intelligent discussions with clinical
FS> colleagues. It is never going to be a
FS> substitute for a medical training.
FS> Unfortunately, there seems to be a trend with
FS> people thinking they are above doing more
FS> traditional aspects of their jobs and seeking
FS> to cadge bits from other people so as to
FS> appear more important and get better paid.
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> Years ago at my Grade A interview I was asked
FS> if I believed there was a place for clinical
FS> scientists. I said that I did (obviously)
FS> because I felt there was a need for people who
FS> understood the fundamental science and could
FS> guide the use of laboratory testing. The
FS> comment of one of the interviewers was telling
FS> - "There are too many clinical scientists who
FS> think they are doctors."
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> You want to be a scientist, you train as a
FS> scientist. You want to be a doctor, you go to
FS> medical school. I wouldn't want to find the
FS> cardiology SHO trying to fix an HPLC. I
FS> certainly don't want my medical conditions
FS> managed by someone who has been on some sort of top-up course.
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> Dave
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> Dr David Hardy
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS>
FS> No virus found in this outgoing message.
FS> Checked by AVG.
FS> Version: 7.5.524 / Virus Database:
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FS>
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FS> This electronic message contains information from Brighton and Sussex University Hospitals NHS Trust, which may be privileged or confidential. The information is intended to be for the use of the individual(s) or entity named above. If you are not the intended recipient be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited. If you have received this electronic message in error, please notify us immediately at [log in to unmask]
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FS> ------ACB discussion List
FS> Information-------- This is an open discussion
FS> list for the academic and clinical community
FS> working in clinical biochemistry. Please note,
FS> archived messages are public and can be viewed
FS> via the internet. Views expressed are those of
FS> the individual and they are responsible for
FS> all message content. ACB Web Site
FS> http://www.acb.org.uk List Archives
FS> http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
FS> List Instructions (How to leave etc.)
FS> http://www.jiscmail.ac.uk/ ------ACB
FS> discussion List Information-------- This is an
FS> open discussion list for the academic and
FS> clinical community working in clinical
FS> biochemistry. Please note, archived messages
FS> are public and can be viewed via the internet.
FS> Views expressed are those of the individual
FS> and they are responsible for all message
FS> content. ACB Web Site http://www.acb.org.uk
FS> List Archives
FS> http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
FS> List Instructions (How to leave etc.)
FS> http://www.jiscmail.ac.uk/
Regards
Aubrey Blumsohn
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