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Richard . "Not just a pretty face", (hopefully not considered dumb and visibly no longer blond)

Richard Mainwaring-Burton
Consultant Biochemist
Queen Mary's Hospital
Sidcup, Kent
DA14 6LT
020-8308-3084

-----Original Message-----
From: TICKNER TREVOR (RM1) Norfolk & Norwich University Hospital [mailto:[log in to unmask]]
Sent: 19 December 2003 10:40
To: [log in to unmask]
Subject: Re: Duplicate requesting

The discussion on repeat requesting and subsequent concerns over our right to exist is interesting, if only to demonstrate the difference in approach between ourselves and others in health care delivery who are much more confident in their own worth.

May I suggest the following are self-evident.

1) All chemistry tests were developed in the laboratory.
2) If we, collectively, are unable to use a chemistry result to add value to the clinical process then other clinicians cannot do so.

3) Objectivity in data usage is part of our creed. This may explain why much of the discussion is concerned with the way we can 'automate' (through computer based rules) our opinions.

4) The rate of growth in test usage (both new applications of current tests or introduction of new tests) is outstripping our ability to develop objective rules or even quantify the limitations of new assays.

I do not believe that the day of the consultant chemical pathologist or clinical scientist is nearing its end. Rather we have to accept the challenge in (yet more) change.

Within the UK we are having to develop strategies for ensuring proper training in use of medical devices. I am a member of a group in my hospital looking into training needs. Two important corollaries have surfaced. Training is not enough. One must certify, both before and periodically, the skills of users of devices. There are two types of device; those used in therapy and those used in diagnosis and monitoring. Use of a diagnosis/monitoring device must include, where appropriate, an ability to 'interpret' the output. Training and ongoing certification means that we have to be involved in devising standards for both use and interpretation and subsequent monitoring of those standards.

It is less a matter of whether our posts are necessary as how we are to find the time to take on expanding roles which we shall, no doubt, try to automate.

Trevor Tickner,
Norwich

-----Original Message-----
From: Mike Bosomworth [mailto:[log in to unmask]]
Sent: 19 December 2003 08:46
To: [log in to unmask]
Subject: Re: Duplicate requesting

There has to be an argument for stopping the more obviously ill-thought out repeat requests. CRP 2 - 3 times in the same day. LFTs 4 times in the same day! We have been heavily criticised for not controlling workload. Whilst I and others argue that we do not make the request (and yes I agree it is a request not an order) we are still seen as being the gatekeepers and surely we are. We are supposed to be experts in  our field and ought to be able to agree logical time periods within which to request repeat tests with our users. If we can use modern technology to enforce those protocols so much the  better. If we can link that technology to on-line teaching aids even better still. Yes there is a cost in terms of time to agreeing those protocols, but once in place the rest, with the right technology, should be pretty straightforward and if nothing else be part of the process for educating those that request our tests - junior doctors (and even drama therapists!!)

With best wishes for Christmas and the New Year to one and all.

Mike

Dr. Mike Bosomworth
Operations Manager for Pathology
Principal Biochemist

Tel. 0113 2064299       Fax 0113 2065971 
 Mobile 07789 174344

Please visit our web-site at www.leedsteachinghospitals.com    

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