This matter is far beyond the mere fact that doctors are deserting consulting rooms to head laboratories. And we both know this.
The Medical Laboratory is not only where investigations are conducted, but also where diagnosis is authenticated or disproved.
We have to tread cautiously, bearing the patient in mind, as we embark on this turf war.
It is a battle that must not even begin in the first place, because it will come back to the same point.
Before I go to the meat of the matter, let me set this preamble:
No one has the right, who is not an employer, to say one employee or another cannot work in a particular space when it comes to matters of life and death.
In the Hospital, the Doctor takes the ultimate responsibility for the decisions he makes about his patients, including the Laboratory Investigations and Imaging investigation requests.
That is why there are specialists in every field of Medicine and Surgery.
All of you Laboratory Specialists in this fight have travelled far and wide too.
You have seen that in Hospitals with Tertiary status like the status of The Greater Accra Regional Hospital, Korle-Bu Teaching Hospital, Komfo Anokye Teaching Hospital, the whole Laboratory Department is branded “Department of Pathology”.
This is because all investigations done in the Laboratory point to one Pathology(Disease) or another.
It is subdivided into:
1. Haematology, where issues related to the blood cells are handled
2. Immunohaematology, Blood and Blood Products are handled as a Prescription for therapy
3. Chemical Pathology, where Whole blood, plasma, and Serum mainly, are investigated for endocrine, exocrine and paracrine hormones, etc
4. Histopathology, with its subdivisions as Cytology, Immunohistochemistry, etc, where products of antemortem (Surgical) and Postmortem (Pathological) are investigated, definitive diagnoses made, and conclusive results issued
5. Microbiology, with its subdivisions such as Parasitology, Virology, Bacteriology, etc, where microbes are investigated from samples like urine, stool, blood, sputum, wound, oropharyngeal swabs and Nasopharyngeal swabs, CSF, Pleural Aspirate, Ascitic Fluid etc.
6. Cellular Pathology: Where DNA, RNA and all the building blocks of the body are extracted, explored and manipulated to give answers and closure to Disputed Paternity, bring joy to homes with issues of infertility, and attempt great feats like Vaccine Manufacture.
In fact, many of the things we’re fighting each other over, instead of coming together to work for our clients, are already in place!
Noguchi Memorial Institute of Medical Research is a Laboratory! Is it not? It was established in Honour of Professor Hideyo Noguchi from Japan, who came to Ghana to research into Yellow Fever, paying the ultimate Price when, in a bid to find a cure for the yellow fever virus, he infected himself.
Hideyo Noguchi was a Medical Doctor, who specialised in an aspect of Laboratory Medicine: Microbiology.
The National Blood Service is a Laboratory for the most part! Is it not?
Blood is collected from donors and Blood Products are generated, banked and distributed per the need.
Our Mortuaries do not have laboratories attached. But there are Pathology laboratories all over. Are there not?
To put this argument into perspective, It is not true that Specialisation in Laboratory Medicine is a three-month course.
A doctor in Ghana must first finish Medical School, do two years of Housemanship, practice as a Medical Officer for two to three years, then write an entrance Exam called ‘Primaries’ to qualify for Membership Residency in Laboratory Medicine at the College of Physicians. This programme runs for three years, where the Resident understudies Professors, treating patients and investigating their ailments…for another three years before graduating as a Specialist. They might want to pursue this further with another three-year Subspecialty to obtain a Fellowship.
So, those who specialised in Haematology, the ones who are called Haematologists, have not abandoned the consulting rooms as we’re being made to believe.
They see the patients who are plagued with the following ailments related to, or associated with, blood in the consulting room:
a. Anaemia of various causes: Nutritional, Haemorrhagic, Haemolytic, Bone marrow failure (aplastic anaemia), Chronic disease, like Chronic Kidney Disease
b. Sickle Cell disease: HbSS, HbSC, Hbβ-Thalassemia, etc
c. Bleeding Disorders: Haemophilia, DIC, Low platelet count…like Idiopathic Thrombotic Thrombocytopaenic Purpura,
d. Leukaemia: Acute and Chronic Forms
Plasma Cell Myeloma (Multiple Myeloma)
e. Malignant Lymphomas: Cancer of the Lymphoid tissue. Of these there are two types: Hodgkin’s Lymphoma and Non-Hodgkin’s Lymphoma.
After seeing the patients above, a Specialist Haematologist has the absolute responsibility to investigate the causes of the diseases by taking samples from various sources for specialised haematological tests.
These tests are not the routine Full or complete blood count tests, or the routine blood film comments or the routine Sickling test with Sodium metabisulphite.
For instance, there is a special kind of cell, the Reed Sternberg (RS) cell, which differentiates the Hodgkin’s Lymphoma (HL) from the Non-Hodgkin’s Lymphoma (NHL). This cell is usually absent in a NHL like Burkitt’s Lymphoma.
It takes the trained eye to identify such a cell from a biopsy of the Lymphoma.
Another example is the further investigation of say, a Complete Blood Count result where all the Cells are below the lower limits of the reference ranges.
Many times, these abnormal results are not even flagged; and no urgency in reporting to the requesting doctor is attached in most cases, nevertheless, some Lab Scientists do call and inform Doctors of the abnormalities they have observed.
Notable among such such Lab Scientists, who will call to flag results and even trigger further remedial action in my Hospital, GARH, include: Mrs Oksana Debrah (PhD), Mohammed Mustapha Seini (PhD), Mr Asante Yeboah, Mr William Wireko, Mr Samuel Kofi Nordzi, Mrs Evelyn Deku, Mr Tahiru Ukasha, Mr Apau.
However, the point I want to make is that, the deeper investigations to unravel the the cause of the symptom in order to treat it leads the Specialist Haematologist to take samples of Bone Marrow, Blood, or even Biopsies of the Liver and Prepare smears of them on a slide.
Where else must the smears of these samples be prepared after being acquired?
In the consulting room? Of course Not!
Where are the Microscopes with which these specially prepared Haematology slides are examined and reported on? In the Laboratory of course.
So, far from the fact that the posting of Haematologists to the Lab automatically means they have come to take Headship of the Lab.
My Laboratory friends, Brothers and Sisters, Fellow Ghanaians,
We have all had a relative, a friend, a family member who has suffered a haemoglobinopathy, who needed to be seen by a specialist Haematologist.
Did we sack the Specialist from the Lab?
Did we put on red bands and declare a strike?
Or we offered the specialist a Karl Zeiss Olympus Microscope with an extra camera lens to take pictures of the abnormal cells in the film Comment for a research paper.
So, is it the case that other patients in similar situation don’t matter?
Let’s ponder over this a while longer.
With All Due Respect to My Medical Laboratory Scientists, it is never going to happen that Specialist Haematologists will take Consult from Medical Lab Scientists regarding Diagnosis, Treatment and Prognosis of their patients’ Haematological disorders.
Why are the Mortuaries not in contention?
Why are we not saying that the Pathologists have taken over the Laboratories? Because they have been in the Labs for God Knows how long now.
In fact, they are the ones to whom Surgeons make requests for Histological and Cytological evaluation and Report.
They are the ones who take the postmortem requests, perform it and report on it.
It is at their behest that tissue Processing, Microtomy, and all the other processes preceding Staining and Mounting are done.
The Patient leaves the house to see the Doctor, and the Buck stops with him.
In case of any outcome, good or not so good, it is he…the Pathologist (generic name for Laboratory Physicians) who is the Expert witness!
But! With All Due Respect to My Learned and Humane Colleagues,
Let’s take our time to explain our points to the public, policy makers and the People contending with us.
Headship of a department in a hospital is the prerogative of the Employer. Not the Employed.
But that Headship must be Merited..
And now, there are PhDs among the Laboratory Scientists. That should count for Something.
There are also Long Service Personnel who have gone through the mail: Certificate, Diploma, First Degree, Masters/MPhil, and are now Deputy Chief Medical Lab Scientists. The Technical Headship of Department should Count for them too.
And these days, to qualify for ISO Certification and Accreditation as a Laboratory of a certain repute or level, there must be certain cadres of
Personnel: Laboratory Physicians or Pathologists, Specialist Laboratory Scientists in certain fields of Lab work, etc;
Departments: Quality Assurance, etc
Our Labs, especially those in Tertiary Hospitals, must begin to aim at such statuses to deliver quality service to our clients, instead of still remaining down there… emulsifying stool for wet mounts, spinning urine for deposits, and Complete Blood Count results still taking 24 hours to run.
Also, just like I have enumerated the reasons Laboratory Physicians cannot be extradited, excommunicated or extricated from the laboratory, so must we take our time to lay bare the facts to those who must judge between our actions and thoughts.
Let us show all the Examples of Best Practices Worldwide.
Doctors work in the laboratory ALL The TIME!
Of course, the thought of the Doctor following through the investigation of his patient is like taking time to dissect an ant in order to discover its entrails.
With All Due Respect to both Parties:
1. The Client is, and must always be the focus of whatever we do
2. We cannot have business as usual after this. Let’s tackle it head-on, once and for all!
For example, it cannot be that the two Highest ISO certified private Labs in the country that readily come to mind, notably MDS Lancet and SYNLab have Laboratory Physicians who make sure the Labs generate the best Results…the reason many Doctors will prefer referring their patients to these labs… while our labs in the public sector are only good for the NHIS card bearers and those on Social Welfare.
3. One does not begin to dance with an axe, just because one is on a genuine course.
The Doctors who are not Laboratory Physicians are still finding ways of getting Lab tests done in the absence of our gallant Lab Scientists, and those who are, are getting their side of the story out there to all who will hear.
The patient is the one in the centre of all these, and is the one who will suffer should the scuffle linger.
Please, let’s find common ground.
4. How I wish we were coming together at this time to generate data on Covid and Post Covid Complications together as Members of the team of Health Professionals and the argument were centred on the Diagmostic Sensitivity, Specificity of the various test methods: PCR and Antigen Test.
Alas! The fight is about He who must lead!
By: Dr Emmanuel Addipa-Adapoe | Medical Officer & Member of the COVID-19 Case Management Team, GARH