Saturday, August 31, 2019

Get back (Musings on transfusion medicine's future)

Updated: 1 Sept. 2019 (Learning pt 4, Further Reading)
August's blog was inspired by a blog I saw on the UK's BBTS website:
  • Transfusion 2024: What did we learn and where will we be? (Further Reading)
To me Dr. Nicholas Watkins' blog had 3 related themes:
  • How to replace retiring staff (and their experience) with new staff, including retaining them.
    • Innovation and technology can help 
    • As can big data (electronic donor and patient records)
The blog's title comes from a 1969 Beatles ditty.


Be aware I've worked in transfusion for decades. My views are biased by long experience as are the opinions of everyone.

In the 1990s I saw how regionalization and centralization of hospital transfusion service laboratories affected staffing, along with semi-automatic instruments. In Alberta, Canada (perhaps everywhere?) that meant many transfusion labs required fewer knowledgeable specialists and could get by with mostly medical technologists who were generalists,  plus lab assistants. Another factor was an AB conservative government that removed 40% of the province's lab budget to decrease a budgetary deficit.

Similar changes across Canada resulted in all medical lab educational programs closing in Western Canada except for the two in Edmonton, NAIT and the University of Alberta's MLS. I taught in MLS but as the University of Alberta Hospital's transfusion service clinical instructor I also taught  NAIT med lab students.

Automation came much earlier to blood supplier donor testing labs. In effect donor testing labs could be mostly staffed by technologists experienced in highly automated clinical chemistry labs.

Learning point #1:
To me, these events meant a huge loss of laboratory transfusion expertise in immunohematology. In Edmonton, Alberta, for example, experienced technologists had to compete for the few remaining jobs based on seniority and many left the field. Those with a BSc in Med Lab Science (who wrote ASCP exams) were able to move to USA (and overseas to countries such as NZ) and work for years.

I don't see 'innovation and technology' as truly helping the loss of expertise except in the sense it means:
  • Med lab profession can be 'dumbed down.' With increasing technology no one needs much expertise to perform routine tasks. And I don't mean generalists and lab assistants are 'dumb', I respect them for their skills, just that their lack of transfusion expertise is the new normal in many labs. 
  • We can only hope so long as serology survives, there's a safety net in all workplaces where the few knowledgeable staff catch any errors.
Learning point #2:
Today the biggie is molecular testing, which means immunohematology expertise will eventually become passé. Presumably, if biotech manufacturers succeed with marketing campaigns that promote matching blood donors and transfusion recipients for antigens with known genes, not just in multi-transfused patients but as the gold standard for ALL transfusion recipients, serologists will no longer be needed.

Transfusion recipients will no longer develop alloantibodies from transfusion, except for ones the DNA PhD gurus haven't identified. But let's hype the hell out of precision medicine to increase profits of commercial interests.

Sounds like a perfect world, no? Local med lab staff numbers shrink to a precious few. Their pesky staff benefits are greatly reduced as an employer cost. Instead of supporting a local economy, money is funneled to foreign biotech companies, who thrive by pleasing their shareholders who grow richer and richer.

Big Data
Yep, big data can provide insights and feed into artificial intelligence (AI) to further remove error-prone humans from healthcare decisions. The downsides include patient privacy and the reality that machines make mistakes. GIGO rules and AI is only as good as human input.

Learning point #3: Privacy is big data's greatest challenge and if it fails (as is likely), big data will become just another failed trend. As to AI, I suspect it's decades away from filling the skilled worker shortage in the transfusion world. But it's already got niche roles in medicine (Further Reading).

Learning point #4: Presumably one day in the distant future AI, automation, and robotics will make human work passé. It's already started and not just on car manufacturing assembly lines. Have you seen the Android robots from Japan or those providing robotic nursing care? With an aging population and worker shortage, robots can fill the bill. (Further Reading)

My vision for the future includes humans who cannot communicate with other humans by talking and have developed enormous thumbs for texting and perhaps sexting. 😉

Choose this Beatles ditty for blog's title song
  • Get back (Paul McCartney, Live in Lisbon 2004)
It's my attempt at a joke as we can never get back to the days where oldsters like me once belonged. 😄

As always, comments are most welcome. And there are some - see below.