Background of the medical laboratory profession
Dr Acquah rightly gave a brief history in which he mentioned the noble works of Rudolf Virchow, Dr Laveran, Robert Koch and many other great scientist who helped in defining medicine as it is today. He however referred to these revolutionary scientist as laboratory physicians failing to realize that most of the current professions stems from main field of medicine.
The fact is that medicine could be traced as far back as 27,000 years ago (25,000 B.C). These ‘healers’ were not necessarily trained and even if at all, they were trained on the table of senior healers just as we see in the current traditional medical practices. Since then, medicine has advanced with time.
Many of the past heroes of medicine could not be qualified as modern day medical doctors even though their work made today’s medicine what it is. Virchow for instance contrary to popular opinion was more interested in microscopic histopathology as a research tool than as a diagnostic aid. To quote Juan Rosai, “…if Rudolph Virchow were alive today he would be a committed molecular biologistsrc.
Most of the early physicians were more of scientist and generally had to handle the whole process of diagnoses and treatment. They undertook scientific processes to come out with findings that is still shaping medicine today.
Where was the medical laboratory scientist all this while? Well, the physician was everything, he undertook observational studies to determine the cause of ailments and then had to find ways of treating. He was the pharmacist, the nurse and almost all health professionals you see today. That was the beginning of the journey of medicine as a whole. Most of this early physicians generally worked in their laboratories making them more of modern day medical laboratorians than medical doctors. You can read more on the history of medicine and you will see that medicine and laboratory diagnoses is not just from a common ancestor but a common parent.
It is obvious that you cannot separate the history of modern medicine from medical laboratory science. In fact, Laboratory medicine only begun to evolve from the general medical practice around the 17th century but was generally still practiced by physicians. As medical care advances there was the need for a specialized field into diagnoses and that was when clinical pathology was born where physicians specialized into performing diagnostic tests for other clinicians to foster the diagnostic process.
However, in the 1950s, the demand for laboratory tests increased, providing an impetus for technical innovation and creating a need for increased numbers of clinical pathologists and faculty of laboratory medicine src.
What one could refer to as a full-fledged modern clinical laboratory was first opened at Johns Hopkins Hospital in Baltimore in 1896 for the assessment of human body fluids src. At this point, the importance of laboratory examination in diagnostics and therapeutics was not properly recognized. Laboratories consisted of a small setup ancillary to the physician’s offices or hospital, with physicians doing the testing themselves. Medical laboratory investigations were generally seen as an expensive luxury and was a poorly understood, vague, and ill-defined occupation.
It was until early 1920s that modern day medical laboratory emerged as a distinct profession. However owing to the realization of the relevance of this field, it underwent a rapid development in terms of the skills and body of knowledge required to practice. At that time physicians worked with assistants and students who were made responsible for running clinical test until it become clear that the role of these assistants needed to become more clearly defined in order for them to competently exercise their duties. At this point clinical laboratory science grew in terms of the number of practitioners and the volume and variety of laboratory tests performed as well as complexity of the testing process.
Advancement of technology in the 1950s led to automation and advance quality assurance systems that defined the medical laboratory practice. Then there was a huge demand for the services of this professionals which led to a widespread of institutions for the training of such professionals who naturally was done by physicians which is inline with the statement of Dr Acquah. The reason was that the profession requires the application of the medical sciences and there experienced physicians had to take that responsibility . Over time this profession developed to the highest level with PhD professionals which necessitated a complete distinction of the faculty of medical laboratory science from general medicine.
The Ghanaian perspective
This general history of the medical laboratory development was not very different in Ghana. The early physicians had to take the responsibility to train assistants to take care of the laboratory analysis giving birth to the practice of this noble profession in this country. The agitation for the establishment of this profession as a distinct one started largely in the 1970s which is merely 48 years ago.
The current state of the profession therefore informs one of how rapid the development had been compared to mainstream medicine which took centuries to grow to where it is today. Dr Acquah mentioned in his write-up that physicians took part in building the current medical laboratory profession to where it is and I agree completely with him. In fact, physicians gave birth to medical laboratory profession but absolutely out of necessity. This is the general rule of progress, you don’t give birth and later claim to be your son do you? I am sure your son has to be allowed to develop on his own without any ‘unnecessary’ interference.
Laboratory medicine today
In many of the developed worlds the medical laboratory is a completely autonomous profession and just like any profession of the medical sector, collaborate closely with clients largely physicians towards improved healthcare delivery for the patient. In his article, Dr Acquah made mention of the fact that different professionals share physical space to work at the hospital mentioning midwives and obstetricians as an example as being regulated by different bodies and working in the same physical space. The question one would ask is, they work as what? The fact that different professions share the same physical space has nothing to do with the reason why medical doctors should work in the medical laboratory.
It is true that the two professions may overlap at certain aspects because of the history of the two professions but that is clearly defined in modern medicine, nowhere in the world does physicians no matter their specialty work in the medical laboratory running routine cases or overseeing the work of laboratory professionals.
The work of physician as far as laboratory medicine is concerned is limited to pre- and post-analytical stages of the laboratory investigation and this does not require sharing of physical space in the laboratory. Physicians may help is sample taking and possibly processing for transport as well as in making use of the test results but not running the test. In practice, some essential service calls for point of care testing. In this case physicians and nurses may be trained to handle that as well as ways to properly select tests and interpret laboratory outcomes. Physician may also help in collaborating with scientist to investigate complex medical conditions such as cancers and other ailments that requires extra information. However none of that calls for a complete set of professionals in the laboratory. In advanced world this is done through a designed system powered by technology.
In made UK, clinical pathology is a medical specialist but their work is in histopathology where they collaborate research work and routine cancer diagnoses but they are co-regulated with other medical scientist by Health and Care Professions Council (HCPC). In such a case other medical specialist who do not necessarily come from general medicine background also collaborate under regulation for the same goal. That practice is open to professionals of Association of Clinical Scientists (ACS) and Institute of Biomedical Scientists (IBMS). It is completely different from the situation in Ghana here therefore trying to mention them as reason to be allowed in the medical laboratory has no much ground to hold.
The local context
In Ghana, the profession of medical laboratory science was established by Health Professions Regulatory Bodies Act (Act 857, 2013) in clear unambiguous terms. If indeed the laboratory physician is nothing new, why do we have to debate about it now? How many laboratory physicians are there already and in which laboratory and in what capacity are these old professionals working in Ghana here?
Nobody is against medical doctors undertaking clinical research and I have seen great works done my doctors that are still continuously defining laboratory diagnoses but that does not qualify them to work as medical laboratorians. In fact, laboratory investigation cannot stand alone as it largely require more information that physician has. The quality of of laboratory investigation indeed requires a well trained physician as majority of errors with laboratory results comes from pre-analytical sources. Physicians therefore may be vital to the quality of laboratory services it does not make them qualified to work in the medical laboratory.
Let’s not forget that even surgery which is a main branch of medicine was developed and still being advanced by scientific studies involving clinical laboratory scientist but does that qualify them to practice surgery? Physician depends on laboratory results to make clinical decisions but does that qualify them to work in the consulting room? Medical scientist train medical students in specific fields such as microbiology, hematology and sometimes even anatomy and physiology but does that qualify those lecturers/trainers as medical doctors?
A look at the curriculum for the said Laboratory physician course shows that it was developed to undermine the medical laboratory profession. You do not have to take my words for it, take a look at a snapshot from their curriculum.
Even for a layman who know nothing about the health sector, this objectives show the intent for the creating of this “medical specialty”. It shows a complete disregard for the law of the country that establishes laboratory science as a distinct profession. These objectives are not meant to provide any complementary work but clearly take over the medical laboratory for their own selfish interest.
Why is there a need for physicians to work in the laboratory with medical laboratory scientist? How can one profession supervise the work of another distinct profession? Are they suggesting that the laboratory practice is more advanced than the professionals? Could laboratory professionals also add two extra years of training to move to consulting room and perform surgeries? Then where does the difference lie? What then makes medical laboratory science as a distinct profession?
Perhaps it could be argued that the objects are only meant to help them better sample collection and interpretation of laboratory results but their curriculum clearly betrays their intentions. It is stated clearly in that curriculum the the resident is expected to work on the bench. In essence, the laboratory physician program is meant to train medical doctors into medical laboratory scientist. Their interest in purely selfish. If medical doctors want to practice medical laboratory science the law of Ghana makes it clear, they should attain a basic medical laboratory science degree, pass professional examination with Allied health Professionals Council and attain the license.
Dr Acquah and his compatriots need to realize that the Health sector is too sensitive for dictionary gymnastics, and dancing around terms as he sought to do with his analysis on the reasons why their agenda is not an illegal one. Ghanaians require clear purpose of the specialty rather than hiding behind the monopolistic nature of the country’s current healthcare systems.
The medical laboratory profession has been developed right to the doctoral level and there is no special role in the laboratory for medical doctors. Indeed, the turf war is completely unnecessary in the voice of Dr Acquah. The Ghana College of Physicians and Surgeons must provide a robust evidence of how this development will lead to improved clinical outcomes or why they think the laboratory scientist in the country are not up to the task.