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>It is my contention that Pathology is an integral part of patient care >and that contact between the lab and the medical staff is as >important a part of the service as the analytical function. These >contacts are best achieved by face to face contacts and not just by >telephone, letter or email. My personal experience is that the need >for constant proactive contact with medical staff is increasing as >training is shortened due to Calman associated with more intense >working and shift patterns for junior medical staff. In addition the >new medical syllabus with problem based learning often leaves >important gaps in doctors knowledge that the lab must provide. > I couldn't agree with you more, as I feel that pathology must be proactive and interactive to provide the optimum help to our colleagues. This used to be the way that our histopathology colleagues in particular justified their number in each DGH, as being an essential part of patient care at the place where the patients were being treated; but the government is getting the opposite message from our colleagues in Lincolnshire which is a huge county but which is centralising its histopathology, I believe in Lincoln, and rationalising other parts of pathology. This has already been cited as a reason for centralisation in other areas in Trent where there are several laboratories. Perhaps a colleague from the area could comment. >One question is, if megalabs are established, what is the role of >the Consultant Chemical Pathologist or Clinical Scientist? Clearly >there will need to be fundamental change. Chemical Pathologists >can of course become more directly involved with patient with >clinics etc., but a new role for Clinical Scientists would need to be >established. Will we even need such individuals and what is to >happen to research? In many ways there is more need for the laboratory to help guide our colleagues. We can do more and more these days but there is a danger of critical results being lost or diagnoses being missed, and with junior doctors covering more patients the possibility of important tests being missed. > >There are I know Pathologists of all subspecialities with grandiose >ideas of heading up these new megalabs and who will have no >problem in closing local services. Sometimes megalabs are seen >as solutions to what otherwise seem insoluble problems of >developing adequate local services. No doubt the provision of >Pathology services can be substantially improved in some cases >by reorganisations. That probably means that heads need knocking together on a local scale rather than throwing everything into the melting pot. I am not convinced of the benefits of economies of scale for routine clinical chemistry (and haematology) once the laboratory is serving about 800 - 1000 beds or a population of about 250,000. For specialities like virology or immunology or toxicology it is different and I don't know what the critical workload is. It probably depends on the service offered. Trevor -- Trevor Gray Dept. of Clinical Chemistry, Northern General Hospital, Sheffield S5 7AU 0114 271 4309 %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%