Look what they've done to my song Ma (Musings on invisible health professionals)

July's blog, another short one, was stimulated by an editorial in the Archives of Pathology; Laboratory Medicine, August 2019: Emerging From the Basement: The Visible Pathologist. (Further Reading)

The editorial reminded me that a hematopathologist I once worked with told me, "Pat, just like medical laboratory technologists/scientists (biomedical scientists in UK, Australia, NZ) feel invisible, at the bottom of the health professional pecking order, so do pathologists of all specialties."

Also on the local scene in Alberta, Canada, a new provincial government just cancelled a needed planned hub lab in Edmonton, with the new government implying they wanted to concentrate on patient care (as if clinical laboratories didn't affect patients) and the centralized superlab/ hub lab was a waste of money best spent elsewhere. The new Premier Jason Kenny argued the changes (new consolidated hub lab) would do nothing to improve patient services.

The blog's title derives by a 1970 song by Melanie Safka.

INTRODUCTION
My take has always been that most folk don't have a clue what medical laboratory technologists/ biomedical scientists do. Suspect they assume we are merely the vampires/blood suckers who draw their blood samples for lab tests. Generally, folks do not realize we are highly educated and trained professionals who play an critical role in assisting physicians to diagnose and treat patients.

PROMOTING THE PROFESSION
Fact is med lab science and clinical labs need to be more visible to the public. In this section I'm going to include tweets of colleagues and former students (my beloved 'kids') who are using Twitter to promote med lab science and make the case for why clinical labs merit respect as playing an as important in patient care.

Tweets and News
Folks you can see tweets without being on Twitter. If you are asked to join, just ignore the dialogue box asking you to join and click on the tweet off the dialogue box. All tweets are short, please read them.

1. Thanks to all who came out to the CSMLS open forum last night

2. AHS Newborn Metabolic Screening program

3. Cancelling superlab undermines foundation of patient care

4. Finally - someone took a look at what's going on

5.  Short-sighted decision to halt ongoing construction of the Edmonton Clinical Lab Hub

6. Yet another example of the importance of lab medicine

7. Pictured here are very passionate medical lab professionals seeking to educate Albertans of the critical role med lab plays in quality patient care 

8. Clinical labs save lives. We have no space & aging equipment. Cancellation of Northern AB Hub Lab leaves us wondering how will this crisis be addressed?

9. Thank you for helping champion the voice of the medical lab profession and its critical role in effective quality patient care.

FOR FUN
I chose this song because I'm disappointed that medical lab technologists (biomedical scientists) still have to fight to be visible to the public, including some politicians, after all these years. I came to the med lab science field by a non-traditional route 55years ago and still we face the same challenges.

• Look what they done to my song Ma (Melanie Safka)

Look what they've done to my song, Ma
Look what they've done to my song
Well, it's the only thing I could do half right
And it's turning out all wrong, Ma
Look what they've done to my song

FURTHER READING
Harrold IM, Bean SM, Williams NC. Emerging from the basement: the visible pathologist. Arch Pathol Lab Med. 2019 Aug;143(8):917-8.

Health Quality Council of Alberta: Provincial Plan for Laboratory Services in Alberta (February 2017)

Leaning into the challenge of medical science (4 June 2019)

The UCP government scrapped Edmonton's 'superlab'. Medical experts say Alberta needs an alternative and fast (24 July 2019)

Medical lab group pushing Alberta government to address gaps after cancelling superlab (24 July 2019)

Alberta government keeps promise to cancel construction of medical superlab (20 June 2019)

Lab Tests Online: For anyone interested in what medical lab professionals do and information on your lab tests results

Both sides now (Musings on where careers take us)

Updated: 2 August 2017

July's blog originated when, after decades of hoarding 'stuff', I finally decided to clean out a file cabinet. In the Medical Laboratory Science (MLS) folder, where I'd taught for 22 years+, I came across a graduation talk I'd given in 1991. The talk got me thinking about preserving (via a blog) some of the history of med lab techs who got caught in the cost constraints of the 1990s and had to work outside Canada. Some eventually decided to transition to other careers. 

The idea for the blog further crystallized when a local radio station used as its 'talking point of the day' 

• 'How did your education (or lack thereof) play into your career? Are you doing the job you trained for and can people still learn on the job?'

I thought the question's focus was slightly off because it assumed that education for a career was mainly for a particular profession's job-specific tasks and ignored all the transferable skills students learn with a good professional education.

Executive version: What follows is an edited version of the grad talk followed by my musings on what happened to the careers of some graduates in the 1991 class. My thesis is that, if education for a career is sound, graduates come out with the self-confidence and transferable skills to transition to wherever life takes them.

Why read it? The educational issues discussed relate to med lab techs/biomedical scientists everywhere and cover a few of the transferable skills essential to any health professional. As well, the blog may resonate with nurses and physicians who find themselves forced to travel to foreign lands for job opportunities. 

Today where I reside (Edmonton, Alberta, Canada), depending on which provincial political party wins the election in 2019, health professionals could find themselves back in the 1990s when medical laboratory technologist, nursing, and laboratory physician jobs all but dried dried up due to the government's obsession with balanced budgets. 

The blog's title derives from an iconic 1967 song written by Canada's Joni Mitchell. I used it once before for a 2013 blog.

GRADUATION TALK TO MLS CLASS of 1991
What follows is an edited version of the talk. It's a run-of-the-mill talk but makes a few points I think are key to a sound education and still apply 26 years later.

Thanks very much Terry for your generous introduction. I am glad to have this opportunity because there are a few things I still need to cover with this class. First, I thought we would have a spot quiz, because students love them. Be aware that some of the answers will only make sense to the graduates. Let’s begin, starting with a test of your long-term memory.

Q #1: How many 1st-year MLS students does it take to change a light bulb?

• Five. One to change it and four to set up Kohler illumination.

Q #2: How many 2nd-year students does it take to change a light bulb?

• None. At least not in my class. You see, they were all asleep during my Powerpoint presentations and the light would only have disturbed them.

Q #3: How many 3rd-year students does it take to change a light bulb? [3rd yr is the clinical rotation yr]

• The whole class. One student to change it and the rest to complain that their friends in other faculties had all summer off to do it.

Q #4: This one is a test of your short term memory. How many 4th-year students does it take to change a light bulb?

• Again, the whole class. One to change it and the rest to complain that it should be deleted from Path 401 [a catch-all course, long since dropped].

Q #5: How many MLS instructors does it take to change a light bulb?

• Ten. One to change it and nine to evaluate whether it was done right.

Now that the spot quiz is over there are a few things that I would like to talk to you about in a more serious vein. 

A few weeks ago I went to the Ambassador Awards at the Convention Centre. It was attended by people from all walks of life who belonged to associations like the CSLT [now CSMLS] that can bring conventions to the city. The organizers gave out awards and asked all of us to act as ambassadors by promoting Edmonton as a convention site. 

The thought occurred to me that in one way or another we all act as ambassadors. For example, when we are tourists in a foreign country, or when we interact with visitors to our city. 

So I would like to talk tonight about the idea that all of you—the MLS graduates of 1991—are going to be ambassadors for MLS whether you realize it or not. No matter what the future holds for each of you, all of the people you will meet will be gaining impressions of MLS through you, your actions, and attitudes. 

Now before you say, “Good grief! I can’t handle the pressure—-MLSers for life”—I want to tell you that I have great faith in each and every one of you. As an MLS instructor I have been privileged to share a part of your life for the past few years. 

Let me explain why I think that you will be great ambassadors. In a way, I feel like the mosquito in a nudist colony. I don't know where to begin.  

First, there are all of the things you have learned while in MLS. And I’m not talking about the knowledge and technical skills you have assimilated, although these are important. You have learned so much that what you have forgotten would fill a library.No—I’m talking about transferable skills that you will find useful all your lives. 

For example, you have learned how to be good listeners. Goodness knows you have had enough practice being listeners during your time here. As you begin your careers, remember the words of a wise person who once said, “good listeners are not only popular everywhere, but after a while they know something.” I have learned much from listening to you over the years.

You have also learned how to communicate clearly, both orally and in writing. Who can ever forget their first teaching assignment? I should explain that our students give at least three oral presentations to classmates and instructors beginning with teaching assignments during 3rd year. 

I’m sure that some of you think that teaching assignments were cruel and unusual punishment—both for the student and the audience. But, boy, do they ever pay off. The progress you made was really shown when you presented your 4th-year research projects. Your instructors and supervisors were impressed. 

This ability for you to make presentations will be a real plus for you in any career. I tell you this because I have listened to many technologists, scientists, and doctors who have not had the advantage that teaching assignments provide—namely to express ideas clearly and concisely. And listening was brutal.

There are many other intellectual skills you have learned. For example:

• Your grasp of the scientific method and all that entails; 

• The ability to be skeptical about so-called established knowledge, and yet to be open-minded about complex issues;

• You know that it is okay to say, “Gee, I  don’t know, but I will find out”;

• Most important of all, you know how to learn. 

You will draw on these skills over and over again— especially because medical laboratory science is evolving so rapidly. 

I would like to shift for awhile to some of the ways you have all grown in your personal development. 

Those of you who entered MLS lacking self-confidence have seen your belief in your abilities increase. Self-confidence is essential because no one will believe in you if you don’t believe in yourself. I’m not talking about being over-confident and self-important, but rather about the quiet self-assurance of people who are competent and know it. 

Conversely, if you came with a fair degree of self-confidence—if you were like me at 18 (and trust me, I was 18 once—and thought I pretty much knew everything) —then your experiences in MLS have added to your growth by teaching you humility. 

Your entire 3rd year was an exercise in discovering your strengths and weaknesses, coming to terms with them, and accepting both praise and criticism gracefully. 

It was hard to be evaluated each and every day of your hospital rotation; it was hard to accept feedback that you may or may not have felt was justified. But you all did it, and because of this you will have a big advantage in the workplace, as well as in life.  

Having a positive approach to learning will always serve you well. You know that imperfection is only human. The important thing is that we all try to do better. And keep in mind that misery is optional. 

You have also learned what friendship means. In the years ahead, you will remember your friends very fondly . One definition of a friend is “a friend is one who dislikes the same people that you dislike.” There is a lot of truth in this, but a better way to think of friendship is to realize that the only way to have a friend is to be one. You have all done that during your university days. 

Let me remind you that universities have always stood for the dignity of each human being—for the belief that each individual is to be appreciated for what they uniquely think, do, and feel. I want you to realize that you are important and have had an impact on your friends and teachers in MLS. 

Earlier I said that, whether you realize it or not, you are going to be unofficial ambassadors for MLS. Over the years, you have seen many role models—instructors, professors, nurses, doctors, and technologists. As ambassadors-—-with personalities and styles of their own—they succeeded to varying degrees in creating good-will for their professions. Soon you too will have this responsibility. 

As you leave MLS, remember the people who have influenced you. Think of those who have treated you with dignity and patience, who smiled rather than frowned, who took the time to criticize constructively, who showed you how to solve problems as medical laboratory scientists, who loved their subject, and who challenged you to be your very best. 

These are the people you will want to emulate as you become role models for others. And now, graduates—this is your night. You have struggled and succeeded in a difficult program. We, your instructors, are very proud of you. You have chosen a rewarding and challenging career.  

In conclusion, it's a cliche but always believe in yourself. You are graduates of the most rigorous Medical Laboratory Science program in Canada and one of the best in the world.  And don't be afraid to dream of what you want in life. No matter what the future holds, you have the right stuff to succeed.

MUSINGS
Of the 22 students in the 1991 MLS graduating class, here's what I know 26 years later about their careers. Most, as would be expected, went on to have careers as medical lab technologists/scientists. But the 1990s brought severe healthcare cuts in Alberta and throughout Canada and jobs became scarce. Graduates' careers I'm aware of:

• Went to NZ to work for New Zealand Blood Service (NZBS) - 2
• Worked for CBS, Canada's national blood supplier for years - 2
• Dentist - 1 
• Lawyer - 1 (after years of working as a med lab tech in Canada and later for NZBS)
• PhD (microbiology) - 1
• Gynecologist -1 (who was in Christchurch, NZ on a fellowship learning advanced laparoscopic surgery when the earthquake struck in 2011)
• Radiologist - 1 (after many years of working as a med lab tech in USA)

To me, this validates that graduates of MLS at the University of Alberta learned many transferable skills and had the self-confidence to believe in themselves and accept challenges, as well as to dream. As one example, the MLS grads who went to NZ to work for NZBS (six in all from several graduating classes) were brave indeed and went through all the government hoops and regulations, requiring incredible stamina and belief that they could do it, no matter what. 

ANECDOTE #1
I'll share correspondence I had with one grad (John) 8 years later (when he was 30 years old) and again, 14 years post-graduation. John, like most MLS grads, had written the USA's ASCP(MT) exams when he graduated from the University of Alberta MLS program. As a result, he could go to the USA under NAFTA with a BSc (MLS) and work in a profession that was deemed needed in the United States. He worked for years as a med lab tech in Montana and also acquired EMS certification and worked part time as a firefighter. 

He wrote me and 3 others in MLS in 1999 because he had obtained his green card and could apply to U.S. medical schools and needed references from his instructors.

Bottom line was that John was accepted into an American medical school in ND, interned in Spokane, Washington, and later got a residency at the coveted Mayo Clinic in 2005, followed by specializing in radiology.He also did a fellowship in Neuroradiology at the Mayo Clinic. 

Mayo Clinic info (1999):"The Mayo residency and fellowship programs are among the most sought-after in the world. Last year, nearly 7,000 people applied for slightly more than 360 positions....Last year, the medical school accepted only 42 new students and only about 5% of those who applied for a residency or a fellowship."

Going back to MLS, in the 3rd year, students rotate through the clinical laboratories in groups of 3 or 4. I distinctly recall John's group because they were so motivated and, more importantly, so much fun to teach. Honestly, everyone should be so lucky to have such students.

John rotated with two female students (Donna and Jennifer), who both went to to work for NZBS in Hamilton, NZ for several years. Jennifer eventually became a lawyer and now works for a law firm in Edmonton where she represents hospitals/health regions and their employees, including AHS . Donna, who prior to NZ had worked for years in a Las Vegas mega-lab where technologists were more like factory workers, later worked for CBS and now works in a local hospital laboratory.

My spouse and I visited NZ for 6 weeks in 1998-99 over Christmas/New Years and touched base with two of the MLS grads, including Donna, who had the courage to go to a foreign country to practice their profession. They had made the best of a bad situation and were loving their foreign adventure.

These grads believed in themselves and were great ambassadors for MLS at the University of Alberta.

ANECDOTE #2
While the MLS grads worked for NZBS, a US software company visited to demonstrate and pitch its blood bank software. Reason I know this is that the software company (Wyndgate Technologies, now Haemonetics Software Solutions) contacted me. 

Specifically, they wanted to know if MLS had more grads like the ones working at NZBS because they were very impressed with them and would love to hire some.

Bottom line: Two MLS grads were brave enough to transition to software testing and moved to Sacramento, California to work for Wyndgate in 2000. One worked for Wyndgate/Haemonetics for 15 years, latterly in a senior management position.

FOR FUN
I chose Joni Mitchell's 1967 song for two reasons. Of note, it has been covered ~600 times by other artists and counting. 

First, I love it. By any standard, Canada's Joni Mitchell is a songwriting genius.

Second, to me it means that life isn't always what you expect it to be. We win some, lose some in the careers we choose but in the end we're left with the illusion of what we hoped it would be. And that's okay providing we acquired the skills to follow our dreams past the illusion. Perhaps too philosophical?

• Both sides now  (Joni Mitchell in concert, 1970)

I've looked at life from both sides now 
From win and lose and still somehow 
It's life's illusions I recall 
I really don't know life at all. 

As always, comments are most welcome.

When sweet dreams become nightmares (Musings on health officials & Big Pharma)

Updated 17 Sept. 2012

August's blog is stimulated by disappointment, even disgust, with those associated with health care who turn out to be dishonorable, i.e., liars and thieves who put their welfare above those they serve.

Would be nice to write a cheery, upbeat theme for the dog-days of summer (in northern hemisphere), but recent news items are enough to make me, and I'd guess most readers, gag.

Regardless of your location, the blog has much food for thought because the issues are global. Honest, you could not make this crappy behavior up.

The title comes from a song by Annie Lennox, a Scottish singer-songwriter and political activist.

ALBERTA, CANADA
These events happened in my backyard but I know it could happen where you live and probably has.

The gist of this sad tale is that Allaudin Merali, hired by Alberta's provincial health system (AHS) as CFO in May 2012 at a salary of $425,000, resigned in July after a CBC reporter broke the story of his exorbitant expense claims ($346,208).

The expenses occurred during his previous employment with Capital Health (before AHS was created) as its CFO (Jan. 2005 - Aug. 2008). For interest, a CFO's responsibilities.

Is Merali an outlier? I suspect not. This type of abuse had to be normal for the health system or it would have been flagged and stopped.

The health region's CEO kept signing off, and who knows for how many others pigs at the trough. You know, all the senior political cronies (oink! oink!) our provincial government appointed to make decisions for us, invariably with minimal or no input from health professionals in the trenches.

To think that my colleagues and I would never include liquor in our expenses (makes sense as it's discretionary spending and not allowed). We'd fly the cheapest airfare, as required, despite inconvenient schedules like red eye flights. Being good employees with integrity, we'd meticulously  use time-inefficient airport shuttle buses so as to keep our expenses minimal in the interest of fairness to those paying.

Not this Merali dude, though. And to top it off, after losing his job in 2008 (when Alberta's health system was reorganized), he received $1 million in severance and a $1.6 million retirement plan over 10 years ($13,303/mth).

17 Sept. 2012: AHS chair whines on cost of audit & info requests into executive expenses (Ya gotta love these guys)

Pretty sweet, eh? (Said the Canuck with a grimace, not a smile.)

GRUESOME DETAILS
News items:

• One place spending wasn't cut (Background on expense scandal)
• Merali resigns after prior expense claims revealed 
• Alberta Treasury Board knew of Ontario controversy surrounding Merali before offering job 
• Former Capital Health CEO Weatherill, who approved Merali expenses, resigns
• Health executives, including former CFO with outrageous expenses, get gold-plated pensions
• Merali's expense claims (obtained by CBC reporter) 

Fascinating stuff. Many routine charges (e.g., conference registration), but who knew the nobs also charge for booze? Fact is, Merali, earning a substantial salary, charged for everything. I bet if he bought a small packet of kleenex or gum drops at the airport he'd have charged them. 

BOTTOM LINE
It's a saga of greed and privilege rampant at the highest levels of a health care system. Leaders are supposed to model expected behavior and instill confidence in a shared vision to benefit all. Gak!

The behavior of this particular Alberta health official falls so short. But he cannot have been alone. If you or I behaved as Merali did (and who knows who else at the top did), we would not, indeed could not, get away with it. Adding to the odious conduct, the situation indicates a double standard that undermines the entire system.

At the same time as Merali was at the trough, Alberta's health professionals struggled to do more with less, as did the entire health care system (too few staff, too few beds, too few long-term care facilities, etc.)

During this time (2005-8), when lunching at a nearby hospital I'd occasionally talk to laboratory technologists who were former students. When asked how things were going, they'd invariably reply anything from not good to brutal.

My next question was, "What's the main issue?" The reply was always a variation of, "Too few staff." So few, that existing staff could not take holidays as there was no funding for part-time or casual staff, even if suitable replacements existed.

Once a PhD lab director stopped by and looked positively ashen. In conversation he noted that what was happening (Alberta's restructuring from multiple health entities to one) was even worse than the 1990s when cost cutbacks were severe and uncertainlty reigned:

• History written at the time (ignore links to news items as they're likely inactive) 

One lab technologist told me that they had a gag order not to talk to outsiders on threat of firing. If Alberta's physicians were bullied, you can bet everyone in the system was.

Charming. What a way to run a health system.

As cost restraints prevailed in the trenches, Merali (and who knows which other senior health officials) was living the high life at tax payers expense. Dining at the most expensive restaurants, getting a phone installed in his Mercedes (Who does this in the age of cell phones?), repairing his Mercedes. It must have been hard to rack up almost $350,000 in expenses over 3 1/2 years.

Is this narrative unique to Alberta, Canada? I doubt it. My take is that it's happening somewhere near you, but you may not know about it yet or ever, unless you have professional reporters who can investigate.

And we know what's happened to real reporters in print journalism in the Internet era. Sites that compile news have gutted the system and users expect news and everything else on the Net to be free.

BIG PHARMA
Big Pharma presents a similar tale of corruption, indeed a worse one. Seems reports of bribery and putting corporate benefit above vulnerable patients never stop.

• GlaxoSmithKline pleads guilty in $3B US drug fraud case

GSK admitted misbranding 2 drugs and withholding safety data for another:

GSK had total disregard for the health of vulnerable people they were supposedly helping - knowing their actions could cause harm, but doing it anyway for self-advantage.
If I did that as a health care professional, I'd be guilty of criminal negligence.

• Pfizer settles bribery charges (11 Aug. 2012) 

With USA regulators clamping down, drug firms seem to have stopped (I say seem because who knows) perks for doctors and similar bribery. But not so in developing countries.

Pfizer's conduct seems to be normal for Big Pharma. 8 of the 10 biggest firms on the planet mention costs for corruption charges as a risk.

Big Pharma's behavior is similar to tobacco firms selling cheap disease-causing cigarettes in developing countries, not caring about those who die. With a decrease in sales in industrialized nations, multi-national companies in the UK and USA decided to spread smoking to developing countries:

• Tobacco and the developing world
• Unstoppable march of the tobacco giants 

Or take the case of our Canadian government (the Harper government as they like to be called), which for a few jobs in Quebec in the asbestos industry, refuses to support a global ban on the well documented killer, asbestos:

• Health Canada's advice on asbestos ban rejected by Harper government

Shameful. Disgusting. Sickening. Criminal. Tobacco companies, Canada's Harper government, and drug companies  - all behave similarly.

MUSINGS
The spectre of senior health officials in my province and their culture of privilege is one thing. I expect it's the same whether in countries with national health care systems (most of the world) or the USA, where private health competitors do whatever it takes to survive and make profits.

What also gets me is that I know several industry reps who are decent individuals. It's hard to think that they work in an environment where bribery and lying are normal. But to think otherwise would be naive. Sadly, evidence to the contrary abounds.

When first entering the health professional many years ago, I had dreams of helping others and being one of the good guys. Definitely a profession that was a notch above used car salesmen, who had a well deserved reputation for lying and cheating customers. But I've learned that health care is also a business, and a nasty, nightmarish  one.

What to do? Focus on the positive in daily work, shine a light on the rats among us, and hold those who tarnish the field to account, a lifelong challenge. Or say nothing, do nothing, be nothing?

FOR FUN
Can there be any fun after such all too real events? Of course. First, a great song that outlines the reality described above:

• Sweet dreams (Annie Lennox) Some of them want to use you...Some of them want to abuse you...

Next, a slightly sappy 1960s ditty that expresses what we hope for all those involved:

• Who's sorry now (Connie Francis)

Lastly, to end on a positive note, and just because I love the song and its fabulous artist appears at the Edmonton Folk Festival this weekend:

• Are you ready for the thing called love (Bonnie Raitt) 

As usual, the views are mine alone. Comments are most welcome BUT, due to excessive spam,  please e-mail me personally or use the address in the newsletter notice.  Great comments below - be sure to read them.