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Train of Thought...
November 2008 -Working with Dinosaurs

We all know them or know of them. Phrases such as "FEV1/FVC please, but hold the loops", "You only need 20 minutes to do spiro, volumes and diffusion", "Why isn't the patient ready yet?" or "FEV1 is simple and well understood so don't confuse things with FEV6" trip off their tongues.

I believe we have come a very long way in our quest to be recognised as professionals in our right. Recent events around the traps, however, have made me wonder if, perhaps, I am wearing rose tinted spectacles - or dirty ones at the very least. In many instances this respect has been hard fought and I think it behoves those of us fortunate enough to work in a more evolutionary enlightened environment to reflect on the privileged situation we find ourselves in. I fear that outside the teaching hospitals things may not be so progressive.

Why might this be? I think there could be a number of forces at work here:

  1. The computerised systems we all use today are a surprisingly recent invention. I well remember the arrival of the Morgan Transfertest at Wellington a matter of weeks after I arrived. It replaced a collection of essentially home grown instruments. Exercise testing was still done with home grown systems. Respiratory Science was just emerging from the research laboratory and labs were mostly run by physicians with a strong physiological base. The investigations we take for granted were not as accessible to all as they are today.

  2. Doctor training was based on the basic parameters being measured viz FEV1 and FVC. This is what the consultants knew, and what they passed on. As time has passed, labs are being run by physicians with less strong physiological backgrounds and this leads to much of the information we can deliver being unappreciated.

  3. With increasing pressure on the depth and range of topics that have to be managed by doctors and the development of increasingly sophisticated software, what I call pushbutton medicine is gaining a foothold. All too often poor quality or invalid data are used to form an opinion. A report can hide a multitude of sins but, when printed, gains an authority that is often not justified. No matter how clever our instruments, at the end of the day the scientist must make the call whether to report something or not.

  4. The milieu in which we work has changed dramatically in the last few years and scientists have gained a lot more responsibility for the quality of the work delivered by a laboratory. As with all change, there are some who struggle to adapt and find themselves unable to cope with the challenging needed to ensure quality work, technical and clinical.

There is no question that there are a lot of issues here. Is there an easy answer? Unfortunately I suspect there is not. Where that respect is not demonstrated, it is necessary to be prepared to work at collecting data to support arguments, for instance, about the time required to get acceptable and repeatable results that do provide an answer to the clinical question being posed. It takes hard work to repeatedly ask for clinical details so you know what question you are trying to answer. It takes hard work to educate the junior doctors about which tests are the most appropriate and what the results mean - particularly when it is difficult to access them.

I do believe that respect has to be earned and I do not suggest for one moment that we should be respected without having to earn our stripes. What is unforgiveable, however, is being denied the opportunities to earn that respect. Being denied the opportunity to practice as a professional.

Are there still dinosaurs about? Unfortunately there do seem to be some about still. To those who have to work with them, just remember what happened to the rest of them. We can see their footsteps in the rocks they walked over, but little else.

'til next month,

K.

November, 2008

kevin.gain@health.wa.gov.au

 

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