Those were the days (Musings on physicians I've worked with over a lifetime)

Significant updates: 12 Feb. 2022 (See #3 below:In memoriam:Dr. David Ferguson)

December's blog is about eight pathologists, hematopathologists and hematologists, I've had the pleasure to work with over a more than 50-year transfusion career. I cannot do them justice so will offer a series of brief tidbits that symbolize how I see them. Some are what folks call 'real characters,' some not, but they all have strength of character and I'll never forget any of them.

1. John Bowman (Winnipeg, Manitoba)
I've blogged on Jack before when he died in 2005:
Dr. Jack Bowman (In Memoriam)
Many tidbits to show why I respected him.

The rest are from my career in Edmonton, Alberta, Canada.

2. Lynn K. Boshkov (Edmonton)
Lynn is such an unassuming person. Loved her tenure at the UAH transfusion service. She was the Medical Director when this case happened

• Case A8: Severe Hemolytic Transfusion Reaction Involving a Student

So respected her when she disclosed and explained what had happened to the patient's family whose loved one had died and supported the staff member involved. Lynn eventually moved to Portland's Oregon Health and Science University.

3. David Ferguson (Edmonton)
As UAH Medical Director David helped me a lot as the clinical instructor to the UAH transfusion service. He eventually moved to BC and later retired. Two tidbits:

The Med Director gave oral exams to all med lab technologist doing their clinical rotation at UAH and I was present to decrease any stress. Once David asked a student which lectin acted like anti-A₁. Her reply was Delicious biflorus (not Dolichos biflorus) at which point he started laughing uncontrollably. Poor kid, I tried to salvage the moment, though I had a huge grin on my face.

Second tidbit is David's reaction to feedback we got on a paper submitted to AABB's Transfusion.

Letendre PL, Williams MA, Ferguson DJ. Comparison of a commercial hexadimethrine bromide method and low-ionic-strength solution for antibody detection with special reference to anti-K. Transfusion 1987 Mar-Apr;27(2):138-41.

AABB reviewers thought we needed to change title to add 'with special reference to anti-K'. We did, of course, but I'll never forget David's venting as only he could do. In retrospect I wish all could see him as I did.

In Memoriam - David Ferguson: Recently learned of that David died on January 3, 2022.He'll be sadly missed by all of Canada's transfusion medicine community.

4. Ed Uthman (MEDLAB-L)
When I created the mailing list MEDLAB-L in 1994, Ed was one of the first to subscribe. He soon became a rockstar and motivated many to love the list and join. He contributed many posts and made the list a success.

• NOTE: Both Ed Uthman and Neil Blumberg gave me permission to post their MEDLAB-L messages.
• Ed's reply to me asking if the list was an anachronism (Beauty!)

Now on Twitter Ed still contributes to pathology worldwide: Ed on Twitter

5. Neil Blumberg (MEDLAB-L)
Neil also joined MEDLAB-L early on and was so generous with answering questions completely and in detail. The wealth of knowledge he has is incredible and that he's so willing to take time to share it with others.Wow!

• Typical Neil reply to a question asked by a list subscriber
• Reply on low lab morale that shows Neil's character 

I'll always treasure Neil's contributions and he's still at it: Neil on twitter

• For fun, question Ed Uthman asked to which Neil replied

6. Ira Shulman (MEDLAB-L)
Ira gave talk at Edmonton conference and I got to know him. Came to my University of Alberta Med Lab Sci office to catch up on e-mail. I erred in ordering wine that was sweet at a local restaurant (horrors!) and especially funny as I prefer very dry wine. We went to the local IMAX theatre as he wasn't into a river valley walk. 

Great guy. Loved California Blood Bank Society (CBBS e-network forum) but it ended.

Once he asked me to present at AABB conference with him, but without financial support as a consultant I couldn't, especially given the US-Canada exchange rate. At ISBT World Congress in Vancouver I enjoyed his OMG comment on all the backup files I had for my Powerpoint presentation.

6. Heather Hume (Ottawa, CBS Head Office)
I worked on contract for CBS under Heather's supervision, along with colleague and friend Kathy Chambers, when Heather was executive medical director, and had the vision that CBS should do more transfusion education. Heather is special.

Together, with input from Dr. Lucinda Whitman, we created a Transfusion Medicine website [screen shot of old site] that has since transmogrified to Professional Education.

At Vancouver at ISBT 2002 Congress when, as a panel member, I noted I'd stayed at University of Alberta Med Lab Sci for 22 years but managed only 9 months at CBS Edmonton as 'Assman,' Heather quipped,~ to 'Pat always wants to end with a laugh.' I'm sure she was thinking much worse, but the classy lady gave me the benefit of the doubt.

7. Gwen Clarke (Edmonton)
I taught Gwen when she was in Med Lab Sci and got to know her better after she became a hematopathologist. In 2006 Gwen and Morris Blajchman edited Clinical Guide to Transfusion, the first to be published online and in print. Believe it or not, I was a co-author (minuscule role) of one of its chapters:

2006 Chamber K, Letendre P, Whitman L. Blood Components. In: Clinical Guide to Transfusion, Clarke G, Blajchman M, eds. Ottawa: Canadian Blood Services, 2006.

Every technologist who works with Gwen respects her. She's a oner. I hope CBS knows how lucky they are to have her on staff.

 8. Susan Nahirniak
I count Susan as one of my Med Lab Sci 'kids'. Despite all my kooky blogs and tweets, Susan never fails to greet me with a warm smile, as here at MLS 2018 reunion. I so appreciate that she forgives me my sins for old time's sake. During our talk her phone kept vibrating because her daughter wanted to be picked up, but Susan kindly ignored the phone.

In summary, I hope you enjoyed these glimpses into encounters I've had with a variety of transfusion physicians over the decades. All are very different, unique, and superb representatives of their profession.

TWEETS
Replies I received on Twitter when I posted this blog. Both have given me permission to post their tweets.
#1 By @shroon7, 1 Jan. 2019
I adored Dr. Boshkov and was @UBB [University of Alberta Blood Bank] as an LAII when she left. Dr. Clarke is also wonderful and I’m glad I still get to talk to her occasionally when she’s on call. RBB’s [Royal Alexandra blood bank] loss was CBS’s gain.Dr. N [Nahirniak] is another fave; more than a few times I’ve been very glad it was her on call. #2 By @shroon7, 1 Jan. 2019
She [Lynn Boshkov] was just so wonderfully “chill” in bone marrows. She had the best ability to keep patients distracted and at-ease during the whole procedure.
#3 By @shroon7,  1 Jan. 2019
To sum up: Considering THREE fabulous hemepaths I’ve had the good fortune to work with are three of your top choices after your long career, I’d consider myself very blessed.

#1 By @DoctorCanBob, 1 Jan. 2019
Lynn was trained in McMaster and was also a superb "clotter".
#2 By @DoctorCanBob, 1 Jan. 2019
Lynn is still doing primarily clotting in Portland at OSMU. 

Also see entire thread of these tweets.

FOR FUN
Could choose many songs for this blog but decided on 'Those Were The Days' by Mary Hopkin. Her 1968 version, produced by Paul McCartney, became a number one hit in UK.

• Those were the Days 

As always, feedback is appreciated. See Comments below.

Take chance on me (Musings on transfusion professionals collaborating)

Stay tuned: Revisions will occur

February's blog was stimulated by the planned transition of an informal mailing list of Canada's Transfusion Safety Officers (TSOs) to the CSTM website. I've been the list manager and moderator since the list ('transfusion')  was created in 2000. The blog is shorter than usual, which is likely a good thing.

As part of the move, we did a survey of 'transfusion' subscribers, many of whom do not have the job title of TSO, but perform many of the same functions. Historically, mainly for financial reasons, most subscribers are Canadian but we've had a few foreign subscribers, including ones from Ireland, Switzerland, UK, and USA.

What is this blog about and why might you want to read it? Many other transfusion-related communication mechanisms (workshops,conferences) exist but today it's often electronic communication, such as websites with discussion forums. In transfusion medicine, PathLabTalk comes to mind, whose BloodBankTalk participants are mainly USA and UK medical laboratory technologists / medical lab scientists. 

Similarly, professional associations like AABB and BBTS offer discussion forums and my experience is that most posts are by technologists.

In contrast, Canada's TSO list includes medical laboratory technologists and transfusion nurses, including blood conservation nurses, and even a few physicians.

That's a huge advantage because transfusion service laboratories and nurses who administer blood transfusion really do need to learn more about each other and appreciate the role each plays.

The blog's title derives from a 1978 ditty by Sweden's ABBA.

HISTORICAL PERSPECTIVE
For decades I've been privy to the views that med lab techs/scientists have on nurses, based on anecdotal experience in hospital transfusion services.

Common themes (misconceptions?) are that RNs do NOT

• Understand quality control procedures and lack competence to do Point of Care Testing (POCT)
• Truly dig the importance of patient identity and understand what can go wrong. Hence they're not that concerned if patient identities on specimen labels do not EXACTLY match those on blood transfusion requisitions, because, hey, they took that sample and know it's the patient.  Hence they think the lab is being anal-retentive on what they see as minor. 

It's possible that nurses have views of their colleagues in transfusion laboratories that are not always complimentary and may be based on sterotypes. I'd love to hear some. 

PARTICIPATION
Transfusion nurses have come relatively late to transfusion organizations. But physicians have belonged for ages, indeed from the get-go. They tend to dominate proceedings as evidenced by talks at annual meetings.

Yet few physicians participate in transfusion lists and forums, or on Twitter. Why not? My guess is that some think of social media such as forums, lists, and Twitter as beneath them. Perhaps some can't be bothered to interact with the hoi polloi, meaning lab techs and nurses or is that too harsh? 

Or, unlike the laboratory and nursing trench workers of the transfusion community, most physicians are too busy (can't bother?) to talk to anyone but other physicians, and only at medical rounds, conferences, etc.? Please advise. 

Three Transfusion Pros Walked Into A Bar
To illustrate my point about stereotypes among transfusion professionals, I created a joke. Yes, it's satire with a smidgen of truth.

A female doctor, medical lab technologist, and a nurse walked into the bar. Oh, great said the bartender, we have a contest tonight and you are just the ones to play it. Out came 2 glasses and the bartender said, 'Guess which one is British and which is Canadian.'

The doctor considered herself a beer aficionado and passed on asking the age and history of the brews. Feeling more knowledgeable than her colleagues, and somewhat infallible, as she often did at work, she immediately stated, based on her gut feeling: Pale lager is Canadian, dark is British.

Canada

Britain

The nurse took and recorded the vital signs, including colour and temperature. She recalled Canadian beer was more likely to be pale yellow and served cooler and that Britain had dark ales. Her guess was the same as the doctor's: Pale lager is Canadian, dark is British.

The lab tech asked if a historical record existed of the samples in the glasses and which bottles they came from, and then demanded it. When told that would be cheating, the technologist replied, 'Sorry, we in the lab don't guess about identity.'

Correct identity thanks to the lab technologist (You knew this was coming):

Canada

Britain

BOTTOM LINE
If only med lab techs/scientists, nurses, and physicians could get to know each other better, transfusion medicine would be a better world. I've been lucky in Alberta, Canada, thanks to the Med Lab Sci program at University of Alberta, to have taught several students who went on to become hematopathologists. Their lab background is a huge plus. 

And I know from the TSO 'transfusion' list that technologists and nurses have benefited from learning the issues and challenges each has.

For interest: In 1994 when the Internet became available at my workplace, I created a mailing list 'MEDLAB-L' for medical laboratory professionals of all disciplines. I could have gone with a transfusion list but am so glad to have opted to be inclusive. Over the years lab professionals (med lab technologists / scientists, PhD level scientists, and physicians) in all clinical labs have benefited from learning about each others' issues.

FOR FUN
The song I chose is a 1978 ditty by Sweden's iconic ABBA. It's meant to say to nurses and med lab techs and physicians to talk to each other on social media, break down stereotypes, trust each other, because we're all in this together.

• Take a chance on me (ABBA)

As always, comments are most welcome.

We can work it out (Musings on transfusion medicine succession planning)

Updated: 21 Mar. 2016 (See Further Reading)

This month's blog derives from a news item in TraQ's monthly newsletter that resulted in my thinking about a topic I've spoken and written about often, succession planning. 

• Why clinical labs and anatomic pathology are at risk because of no formal succession plan to develop their next generation of management leaders (Dark Daily, 16 Mar. 2016)

The Dark Daily report focuses on succession planning in US clinical labs and anatomic pathology. To me it encompasses several related issues.

My musings focus on why succession planning is a challenge in today's clinical laboratories and what I see as the main way it can realistically happen.

The blog is written from a medical laboratory technology perspective, as that's my background, but the issues also relate to nursing and physicians.

For example, as someone involved with helping seniors in their 90s who often go to Emergency Departments in ambulances, and later become what are disparagingly called 'bed blockers' in acute care hospitals, I see how short-staffed and stressed nursing staff are in both acute care and long term care facilities. To think these nurses, or the health care system in general, could ever prepare for succession planning beggars belief. Yet many nurses no doubt mentor their colleagues.

As for physicians, and hematopathologists in particular, mentoring happens due to the efforts of exceptional physicians. These professionals give above and beyond. I often see them answering queries at 11 pm, well after their work day ends, indeed after they've tended to family responsibilities.

The blog's title derives from a 1965 Beatles ditty.

For links to news item and resources, see Further Reading at the blog's end. Please take time to read the sample quotes from those who lived through restructuring and centralization. They're enlightening.

MUSINGS
CHALLENGE #1: Decreased CPD / CE
Decreasing budgets mean less money to train managers. Indeed, often money for continuing professional development (CPD) / continuing education (CE) all but dried up post-laboratory consolidation.

If money were available for regional and national conferences, it went to medical directors, and perhaps to a lab manager, if any was left over. Sometimes medical directors paid part or all of their own expenses, leaving CPD/CE budgeted funds for managers and supervisors.

Today in Canada, some 20-25 years post-regionalization of laboratory services, clinical lab staff are mostly unionized and have contracts giving some degree of support such as 3-5 days paid leave for CPD/CE. But transportation to and accommodation at conferences often run over $1000, making attendance all but impossible without support.

In many cases, attending conferences also requires a supportive spouse and family to tend to extra duties with children, and generous colleagues to take up the slack at work, because while you're away, adequate replacement staff (if any at all) are seldom brought in.

Although valuable, the main benefit of conferences is not so much in hearing the latest and greatest from speakers (researchers and 'thought leaders'), but rather in socializing with peers.

It's in the socializing that you learn the goodies and tidbits not found in journals and not presented at conferences.

CHALLENGE #2: Decreased Mentoring
Staffing cutbacks leave remaining managers and administrators little time to mentor those with promising management and leadership skills.

Today it takes staff all their skill and energy to produce reliable lab test results that physicians rely on to diagnose and treat patients.

For example, with centralization and regionalization of laboratory services in the 1990s in Alberta,Canada, the first to go were middle managers. In this case, career lab technologists in affected hospitals - all experienced managers and supervisors - were left competing for the few remaining positions.

• To see the reality of what lab regionalization means to people, see CSTM's blog on Dianne Powell below.

Under such circumstances, successful candidates often find themselves stressed to the max, not only with an extra workload, but often in unfamiliar surroundings (e.g., a different hospital in the same city).

Other contributing factors to stressed and overworked staff following lab centralization include

• After significant change, many staff are so stressed that they may become negative, opting to do the bare minimum required for the job and fostering 'bitch sessions' at coffee and lunch. Even 'keeners' can be brought down by a steady diet of negativity.

• Some staff come to believe, sometimes with good reason, that the organization is not loyal to them and they reciprocate the perceived feeling. Work may then become a '9-5 job' (just to earn $) as opposed to a career (lifelong journey to fulfill personally rewarding goals).

• With centralization, more automation invariably follows because volume makes the instruments more affordable, especially given that fewer higher paid technologists are needed. To some lab workers, once the thrill of something new and shiny subsides, automation is 'okay' but not particularly rewarding.

Frankly, working with their hands and problem solving were the magical magnets that drew many to working in transfusion labs (and also microbiology). Loading mega-specimen trays, pushing buttons, and watching the instrument's software spew out results is not the most rewarding to such folks.

At the same time as automation occurs, specialized staff are lost and more generalists, as well as laboratory assistants, are hired to be supervised by a shrinking number of specialists. All of which contribute to overwork and increased stress in managers. The priority is for labs to become huge factories churning out products (lab results).

Mentoring future leaders becomes tougher and requires incredible effort by truly dedicated lab managers.
 
LEARNING POINTS
1. Health professionals should give themselves every educational advantage.

Especially in the 1990s, many exceptional Canadian laboratory technologists (and those of many nationalities) were forced to leave the profession due to lack of jobs. Others with appropriate credentials found work internationally. A BSc in Med Lab Science helped. Suspect a BSc in Nursing helped too, at least for working in the USA under NAFTA.

2. After large-scale centralization, or massive change of any kind, managers must have emotional intelligence.

• Emotional intelligence (OED)
• Emotional intelligence (Psychology Today)

From my brief experience in the world of management, managing staff is more important than all the experience and knowledge in the world (which also counts on the respect metre).

3. Formal succession planning? Are you kidding? A formal plan is tough. Mentoring is where it's at.

I know several med lab technologist leaders who continue to mentor staff informally. Mentoring occurs in nursing and among transfusion physicians too. All by folks I call the 'special ones' - health professionals who love their careers and go the extra mile to share the nuggets they've learned over many years.

Personally, I've had many talented mentors over the years. The first was Catherine Anderson, the lab manager at Canadian Red Cross Blood Transfusion Service in Winnipeg, when I was a kid of 21 years. She had CRC-BTS fund my way to local, national, and international conferences and workshops, had me speak in her place at conferences (at first I was 'shaking in my boots'), and left me in charge of a few administrative tasks when she was away. 

Plus when I screwed up, and I did, it was a learning experience, not the blame game. 

I'll mention one other mentor, Dr. David Ferguson, Medical Director of the UAH transfusion service in my days in MLS, University of Alberta, where I was also a clinical instructor for the UAH blood bank.

What David did was treat me as an equal, although I definitely was not. We shared many a laugh over student oral exams (Delicious biflorus being an answer one student gave to 'What is the the anti-A1 lectin?'). We also co-authored an immunohematology paper published in Transfusion. His reaction to reviewer feedback still makes me chuckle  today.

Mentoring is what develops future leaders in any field. Mentors come in all shapes and sizes. Some fear and resist change, others are big-picture visionaries who welcome change. A mentor's key characteristics? 

• Encouraging staff to be all they can be.
• Modelling how exemplary professionals think and act.

As always the views are mine alone and comments are most welcome.

FOR FUN
I chose the blog's title song for its lyrics about life being short and there's no time to fuss about. Mentor potential lab leaders NOW or the proverbial poop will hit the fan as experienced staff retire in increasing numbers.

• We can work it out (Beatles, 1965)

Life is very short, and there's no time
For fussing and fighting, my friend
I have always thought that it's a crime
So I will ask you once again

Try to see it my way
Only time will tell if I am right or I am wrong....

FURTHER READING

• Why clinical labs and anatomic pathology are at risk because of no formal succession plan to develop their next generation of management leaders (16 Mar. 2016)

• Developing the next generation of lab leaders (Nov. 2015)

CSTM 'I will remember you' blogs (in alphabetical order) 

Sample quotes related to this blog's theme

NOTE: These blogs are based on my interviews with health professionals, leaders in their field, to celebrate their outstanding careers, awards, and accomplishments. Refreshingly, besides all the things they loved about their transfusion medicine lives (read the blogs!), they also speak frankly about regrets and the realities of laboratory consolidation and cost constraints.

• Kieran Biggins (17 Jan. 2016)
• Also, I regret allowing myself to be consumed by change fatigue during the last few years of working for Alberta Health Services.
• ...I became the first Transfusion Safety Officer (TSO) in Alberta. Unfortunately, as the healthcare system in Alberta was consolidated yet again and again, my employer felt it necessary to add additional responsibilities to my new position such that I soon had two full-time equivalent responsibilities: TSO and Laboratory Quality Assurance Supervisor!
• In the last few years of my employment with AHS, there was an overwhelming culture of DON'T question any changes, keep your head down, don't make waves and don't rock the boat. Unfortunately,  this (as you know) is not me....

• Kathy Chambers (8 Jan. 2016)
• Accomplishments and fun: Managing a team of smart, empowered women who made the transfusion service as good when I was not there as when I was.
• This happened at RCH in New Westminster. From designing a new lab, working in less than good circumstances... moving into the new space and doing great work in their day-to-day duties, I think we truly had a quality system before it was introduced into labs.
• Others: Having good mentors to make me a better person...
• Attending conferences all over the world, meeting and networking with fellow TM practitioners. Loads of memories and great friendships.

• Kate Gagliardi (20 Mar. 2016)
• 'Regionalization – most of us minions had no control over fundamental changes in the environment which led to multi-sited organizations – and yet I sincerely missed the glory days of a single-site academic institution and the world within it that we had created.  It would have been nice to retain some of the good things – tight, dedicated teams, which endured despite changes in the personnel and services.'

• Dianne Powell (7 Feb. 2016)
• As a cost cutting measure, the RAH and Charles Camsell Hospital laboratory services were to merge. The process involved much uncertainly and anxiety. Our laboratory manager at the Camsell was given a package and quietly disappeared and staff felt quite un-tethered. As supervisors, we tried to provide support for the lab staff as we were dealing with the uncertainty, but as supervisors we were also dealing with maintaining the daily routine in the lab and ensuring testing got done.
  
  And we were told almost immediately that
  
  • We would need to submit our resumes and compete with our counterparts at the RAH Laboratory for our positions.
  • If unsuccessful in the competition, there was no place in the organization for us.
  • We would be given a package and be asked to leave immediately so we should have our personal stuff packed up.
  • Sounds like the reality TV show 'Survivor', no?

Mommas, don't let your babies grow up to be hempaths (Musings on evolving TM careers)

Updated: 14 July 2015

July's blog was stimulated by a paper in ASH's journal, Blood (see Further Reading):

• Wallace PJ, Connell NT, Abkowitz JL. The role of hematologists in a changing United States health care system. Blood. 2015 Apr 16;125(16):2467-70. Epub 2015 Mar 6. 

The blog's title derives from a 1970s ditty associated with Willie Nelson.

What follows is my brief take on ASH's initiative for hematologists, including possible parallels it has, or doesn't have, for transfusion-related nurses and medical laboratory technologists / clinical laboratory scientists worldwide. At core, it's a tale of how to promote your profession and earn a living when the universe does not unfold as you thought it would.

Keep in mind I'm not a physician, let alone a hematologist / hematopathologist, so my take is born of ignorance. But I've never let facts spoil a good story, so here goes.  First the paper's overview:
ABSTRACT

Major and ongoing changes in health care financing and delivery in the United States have altered opportunities and incentives for new physicians to specialize in nonmalignant hematology. At the same time, effective clinical tools and strategies continue to rapidly emerge. Consequently, there is an imperative to foster workforce innovation to ensure sustainable professional roles for hematologists, reliable patient access to optimal hematology expertise, and optimal patient outcomes.

The American Society of Hematology is building a collection of case studies to guide the creation of institutionally supported systems-based clinical hematologist positions that predominantly focus on nonmalignant hematology. These roles offer a mix of guidance regarding patient management and the appropriate use and stewardship of clinical resources, as well as development of new testing procedures and protocols.

MUSINGS #1  - Systems-based hematologists
The authors imply that nonmalignant hematology is a career path that's opened up for hematologists to earn a buck and sustain their careers. In the full paper they note that traditional roles (malignant hematology) are sucking up the jobs, leaving few for others, especially non-specialists.
Excerpt:

Although this forum focuses on the United States health care system, similar issues exist elsewhere, including outside of Canada and Europe.

For example, Dr. Andrew Roberts commented that in Australia, where hematologists have traditionally been trained dually as internists and hematopathologists,

'Clinicians with high-level expertise in care of acute and chronic nonmalignant hematology have been squeezed out of appointments in both diagnostic laboratories and hospital departments dominated by subspecialized malignant hematology' (Andrew Roberts, Royal Melbourne Hospital, personal communication, January 27, 2015).

Hence, the authors propose what they call 'systems-based hematologists', ill-defined because associated expertise permutations are many. Using 'systems-based' is fascinating. I'm tempted to say it borders on bafflegab. 

What does it mean? In plain language please. Cut the weasel words. Does systems-based relate to

• Systems thinking involving a holistic approach to all the parts of any health system? Even including, as stated in the paper,  non-medical areas such as information technology specialist, hospital quality control officer, and safety officer? In which case, perhaps systems-based is a jack-of-all-trades approach. One that encroaches on roles often fulfilled by other health professions, and even far-removed from medicine such as information technology?

Nice thought but uh-uh! Too ambitious for most hempaths. Best stick to nonmalignant hematology, where validated expertise exists.

MUSINGS #2  - Hematologists, pathologists, and weirdos
Interestingly, in Canada (and the USA), hematology is a sub-specialty of internal medicine:

• Hematology profile (CMA)

Whereas hematological pathology education and training takes place in Departments of Laboratory Medicine and Pathology, at least at the University of Alberta where it is a 4-year post-graduate specialty. Likely many variations of education exists worldwide. 

For example, in the US, hematopathology is a board certified sub-specialty practiced by physicians who have completed a general pathology residency (anatomic, clinical, or combined) and an additional year of fellowship training in hematology. 

Pathologists identify diseases and conditions by studying abnormal cells and tissues.  A joke to illustrate:

• An internist, surgeon and pathologist go duck hunting

In the grand scheme of medicine, historically pathologists have gotten a bad rap as Weirdos.

Perhaps it's performing autopsies on the dead that falsely defines them in the public's eye as docs who deal only with dead people, often in dingy basement labs. 

As opposed to the reality of physicians who diagnose disease and offer treatment options to front-line docs. And many treat patients personally, as front-line docs, in the case of hematologists as opposed to the more lab-focused hematopathologists.

Even today in the realm of 'sexy' forensic pathology TV shows such as NCIS, the pathologist is eccentric:

• Dr. Donald  'Ducky' Mallard

As an aside, I taught in a windowless basement lab for more than 20 years. Every spring it would flood as the snow melted. Trapping mice was ongoing entertainment. But so far as I know students were not brain dead from having so much information and problem solving thrown at them.

Personal anecdotes
1. Long ago a beloved and respected pathologist who headed a university department I worked in looked nothing like what he was. I once pointed him out to my spouse in a grocery store and asked him to guess what he did. Reply: Maybe down-on-his-luck, soon-to-be homeless dude?

He wore old baggy suits, bicycled to work, shyly looked the other way if you met him in the hallway. Superficially he was a odd-bod eccentric. In reality he was a brilliant pathologist and one of the kindest guys you could ever meet.

2. Once mentioned to university department head, a hematopathologist, that lab technologists/scientists were at bottom of the healthcare totem pole because we had little interaction with patients except as blood collectors (think Dracula), now not even that, as specialized phlebotomists are the norm. 

His response: 'Pat, it's similar for pathologists, we're at the bottom of the physician totem pole.'

3. Briefly worked with a hospital transfusion service medical director who's background was as a hematologist from the UK. He had a hard time in his job because he lacked the in-depth laboratory skills and transfusion medicine expertise of Canadian-trained hematopathologists. He thought it stupid and odd that NA MD training split the two:

• What is the difference between a hematologist and a hematopathologist?

4. When I think of all the physicians I know, the ones who stand out as exemplary are hematopathologists. Maybe it's because I taught them in a prior life or know them as colleagues and people. But equally likely it's because they are exemplary on many levels. Most are the antithesis of the weirdo stereotype, people-persons fully engaged with the world and their colleagues, making a difference.

MUSINGS #3 - OTHER PROFESSIONS
Are there parallels in nursing or med lab technology/science with ASH's call to develop systems-based hematologists?

1. Nursing
Nurses, including transfusion specialists, are in demand and have done well by their venture into transfusion medicine. But funding of transfusion positions is always a challenge as in Australia's example below.

Source: Abstracts of ISBT Regional Congress and conjoint BBTS Annual Conference, London, UK, June 27-July 1, 2015 (See Further Reading)

2D-S08-01: My role as a transfusion practitioner in a UK NHS  teaching hospital (Excerpt)

2010 survey in England and North Wales: Transfusion Practitioners (TPs) made a significant contributions to improve transfusion practice at local, regional and national levels by promoting safe transfusion practice, appropriate use of blood, reducing wastage, and increasing patient and public involvement ensuring that Better Blood Transfusion has become an integral part of NHS care. 

Anecdotal evidence shows that the role and responsibility of the TP varies widely and has changed for most since it was introduced over 10 years ago, with significant variation in how TPs spend their time.

2D-S08-03: The role of the transfusion practitioner in Australia (Excerpt)

Currently there are 113 dedicated TP positions and many more staff involved as blood/transfusion champions. There are also 12 TP positions within the Australian Red Cross Blood Service (ARCBS). 

Education available in Australia to support the TP role and others working in the area including the Graduate Certificate in Transfusion Practice, BloodSafe eLearning Australia, and an extensive range of learning experiences offered by the ARCBS. In this tight economic environment there is constant pressure in all states regarding the funding of these positions.

Similar to American hematologists, perhaps transfusion-specialist nurses would benefit by highlighting more general ways they add value to the health care system?

2. Medical laboratory technology / clinical laboratory science
Several years ago there was a movement in Canada, perhaps elsewhere, to get med lab techs on healthcare teams that went on patient rounds. 

The discipline chosen for the experiment was clinical microbiology and the tentative name for the new category was clinical technologist, meaning health professionals who observe and treat patients rather than theoretical or laboratory studies.

Nothing much came of it. So far as I know, it failed. As an example, what's missing from this TOC?

• Guide to Interdisciplinary Team Roles and Responsibilities

Why did it fail? Maybe because clinical microbiologists exist higher up the totem pole, either with MD or PhD degrees.

From a broader perspective, lab professionals have a huge career liability, namely technology.  Anything that eliminates humans from the process (and concomitant human error), is valued above all. As is technology-associated automation that eliminates staff and their ongoing financial liabilities like benefits and pensions.

BOTTOM LINES
In a time of cost restraint, all health professions are wise to seek unique niches showcasing and promoting special skills that enhance patient well being and safety, as well as their own careers. Then we rely on health policy analysts who advise government to be objective / evidence-based and for politicians to put public good above partisan political dogma. 

At which point, I admit to ROTFL.

Perhaps one day physicians, like medical lab technologists, will be told the equivalent of

• We've got a device that frees you up from many mundane tasks so you can concentrate on using your core skills to the max 

Actually, that's already happened. They're called nurses, occupational and physical therapists, pharmacists, etc. And, physicians often fight them tooth-and-nail to protect their turf and scope of practice, all under the umbrella of patient safety.

An exception is Alberta's Primary Care Networks, so maybe the times they are a changin'.

Update (14 July 2015): A recent news item on TraQ relates to changing times:

• Iggbo connects doctors with phlebotomists through a mobile app (~Uber cabs) 

Iggbo is a US company similar to Uber, except the mobile app connects physicians with freelance phlebotomists in the locale who collect blood for the ordered tests. The idea for the business was stimulated by a government crackdown on the practice of paying process-and-handling fees to doctors that could be considered kickbacks. (See Further Reading for background)
The Iggbo app fits with an earlier tongue-in-cheek blog: 

• Islands in the stream (Fun musings on TM's crusade to cut costs - there's an app for that!)

Perhaps workforce innovation to ensure sustainable professional roles for hematologists will one day include freelance, system-based clinical hematologists. 

Hempaths who meld mobility, flexible lifestyle, and entrepreneurial spirit with tech-based logistics (apps) to support reliable patient access to hematology expertise.

FOR FUN
Some songs apply to many professions, including health professions. This Nelson ditty epitomizes the issue, as does Dylan's. And you must admit that both icons overcame their nasal singing voices with content that resonates.

• Mommas, don't let your babies to grow up to be cowboys (Willie Nelson, Farm Aid, 1985)

Or for a real trip down memory lane

• The times they are a changin' (Bob Dylan, 1964)

As always comments are most welcome.
FURTHER READING
1. Wallace PJ, Connell NT, Abkowitz JL. The role of hematologists in a changing United States health care system. Blood. 2015 Apr 16;125(16):2467-70. Epub 2015 Mar 6. (Full free text)

2. How docs pick their residency (Scroll to Pathology)

3. Abstracts of ISBT Regional Congress and conjoint BBTS Annual Conference, London, UK, June 27-July 1, 2015 (See p. 8 for the transfusion practitioner abstracts)

4. As background for Iggbo: WSJ exposé puts HDL on the defensive