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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: FS> 269.23.3/1393 - Release Date: 23/04/2008 08:12 FS> FS> ------ACB discussion List Information-------- FS> This is an open discussion list for the FS> academic and clinical community working in FS> clinical biochemistry. Please note, archived FS> messages are public and can be viewed via the FS> internet. Views expressed are those of the FS> individual and they are responsible for all FS> 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/ FS> FS> FS> 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] FS> FS> FS> This Trust is committed to openness and transparency, and this commitment is supported by the Freedom of Information Act 2000. Under the Act, any recorded information held by the Trust, including this message, unless legally exempt, may be subject to public disclosure. FS> FS> FS> Activity and use of the Brighton and Sussex University Hospitals NHS Trust E-mail system is monitored to secure its effective operation and for other lawful business purposes. Communications using this system will also be monitored for viruses and other harmful material. FS> FS> 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 ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/