BRITISH MEDICAL JOURNAL
23 APRIL 1977
1081
CORRES PONDENCE Cyproheptadine and Cushing's disease A W Burrows, MRCP, and others ........ Children at risk P C Corry, MB; G T Meredith .......... Fatal oxprenolol poisoning P Turner, FRCP ...................... Tuberculin reversion rate H G Calwell, MD; K M Goel, MD, and others .............................. R J Hetherington, MB; Z B Tabara, FRCS. . 1082 Atropine or thymoxamine for chronic Practice in Canada asthma? J B Morison, MD ...................... 1083 E N Wardle, MD ...................... Impeccable syllable Factor VIII and chronic renal failure P J E Wilson, FRCS .................... 1083 Z M Ruggeri, MD, and others ..... ....... Fractures of the tibia Bromocriptine for severe mastalgia R Ger, FRCS . B V Palmer, FRCS, and J C M P Monteiro, ................ MD ................................. 1083 Alcoholic liver disease in women A N Hamlyn, MRCP .............. Bromocriptine for Cushing's disease SOMA A L Kennedy, MRCP, and D A D MontPhilippa MacLiesh .................... gomery, FRCP ........................ 1083 Staffing in the medical laboratory service F J Baker, FIMLS, and J K Fawcett, FCIS; I J Y Cook; R Holman, FIMLS; J C Giddings, PHD; L G Whitby, FRCP, and others .............................. 1081 Commitment to oncology .............. 1082 J Walter, FRCR .......... Breakfast and Crohn's disease
Correspondents are urged to write briefly so that readers may be offered as wide a selection of letters as possible. So many are being received that the omission of some is inevitable. Letters should be signed personally by all their authors. Staffing in the medical laboratory service
SIR,-Your leading article of (2 April, p 866) and recent correspondence (26 March, p 833) demonstrate that inferences going beyond what we stated and intended have been drawn from our policy document on staffingl and from our evidence2 to the Royal Comnuission on the National Health Service. These documents, contrary to the conclusion of Professor Whitby -and his colleagues, were widely distributed, the recipients including the Royal College of Pathologists, the Association of Clinical Biochemists, the Department of Health and Social Security, the Scottish Home and Health Department, and all regional scientific officers. We must reiterate that the institute did not deny pathologists their proper role in medical laboratories but decided that matters relating to medical staffing should be left to the medical profession. The tone of the criticism directed at us recently leaves little doubt that we would have been even more severely castigated if we had presumed to comment on medical staffing. As the leading article and correspondence raise many issues, we must confine ourselves merely to correcting some errors of fact. Both the article and the letter from Professor Whitby et al perpetuate the mistake of referring to graduates and technicians as if they were two different occupational classes, whereas "technician" describes someone designated in a certain way by the Whitley Council and "graduate" describes someone possessing a certain kind of qualification. Far from being mutually exclusive groups, most "graduate scientists" entering the medical laboratory service are being appointed as "technicians." This reflects a logical and inevitable evolutionary change which goes back over 20 years and is not, as Professor Whitby and colleagues suggested, merely "a reflection of the current economic situation." This institute has advocated for nearly 10 years that changes should be made in medical laboratory staffing to eliminate the confusion
Paracetamol-induced acute pancreatitis R A Coward, BM ...................... Therapeutic test with colchicine in diagnosis of gout 1084 P L Kinsella, MRCP .................. 1084 Interviewing women applicants Christine M Gaston, BM ......... I..... Increased university fees and graduate medical students 1084 D P Gradwell, BSC .................... Administrative staff in the NHS E J M Weaver, FRCS .................. 1085 Choice of BMA division C A K Bird, FRCPATH .................. 1085 Hospital practitioner anaesthetists: requirements for appointment 1085 D P V L Giles, MRCGP ................ BMA and medical indemnity 1085 W Gault, FRCOG ...................... Getting the contract right N H N Mills, MFCM .................. 1086 1084
1086
1086 1086 1086 1087
1087 1087 1087
1087
publish a letter from one of its own members because the writer criticised this staffing document, even to the conclusion of accepting readily that member's resignation. I therefore do not feel bound to defend the IMLS, who are apparently set on a suicidal course. However, many of us do feel obliged to reassure pathologists that the majority of senior chief and principal technicians have no clandestine plans of a coup d'etat in pathology -only a desire to participate in laboratory management for the benefit of the department and the service as a whole-a fact sadly ignored by HSC(IS)16 and undoubtedly a cause of much of the present unrest.
resulting from use of the term "technician." Your leading article proposed that the hospital scientific service might adopt a staff structure comparable with that in the Scientific Civil Service. That is just what we have been saying for years. The only difference is that you described the obsolete system prevailing before publication of the Fulton Report3 in 1968, as a consequence of which an integrated structure was introduced. The system for the nonI J Y COOK Principal Technician medical staff of medical laboratories must be brought into line with other forms of employ- Area Department of Pathology, ment, including the modem Scientific Civil Exeter Service. F J BAKER SIR,-In common with thousands of my President colleagues I have no objection to my consultant J K FAWCETT pathologist having "control of all the resources Secretary, Institute of Medical Laboratory Sciences of the laboratory" (2 April, p 866). What I do object to are the proposals put forward by London WI certain professional bodies which, as I see l Institute of Medical Laboratory Sciences, Future them, unfairly judge my 20 years of practical Staffing in the Medical Laboratory Service. A Policy experience (12 at a senior level) against even Statement. London, IMLS, 1976. 'Institute of Medical Laboratory Sciences, Etidence recently obtained higher academic qualificato the Royal Commission on the National Health tions. Service. London, IMLS, 1977. 'HM Treasury, Report of the Committee on the Civil I would respectfully suggest that a confusion Service 1966-68. HMSO, 1968. of terminology is in existence here-a conunon occurrence within hospital laboratories. Is not the consultant the director, and the chief SIR,-I suspect that many medical- laboratory technician the manager'? If it helps anyone's technicians will be equally incensed by the sensitivity I would always agree for technical institute's document "Future staffing in the to be appended to the latter title. Perhaps all Medical Laboratory Service" as Professor L G grades of medical laboratory staff could look Whitby and others were in their letters (26 closely at the sentiments expressed in Dr H A March, p 833). Many of the more senior Lee's letter (2 April, p 902) and remember that medical laboratory technicians were concemed the axiom "patients before politics" applies at that such a document would inevitably cause a local as well as national level. deterioration in the working relationships R HOLMAN between pathologists and technicians. No doubt Senior Chief Technician, Biochemistry Department many of the present institute council members have forgotten, or choose to forget, that the Bexley, Kent present status of medical laboratory technicians owes much to the co-operation and support, particularly in the past, of eminent pathologists. SIR,-Recent correspondence in the British It is also equally disturbing that the institute Medical J7ournal and the leading article has become so undemocratic that it refused to (2 April, p 866) focus on what appears to be a
23 APRIL 1977
1081
CORRES PONDENCE Cyproheptadine and Cushing's disease A W Burrows, MRCP, and others ........ Children at risk P C Corry, MB; G T Meredith .......... Fatal oxprenolol poisoning P Turner, FRCP ...................... Tuberculin reversion rate H G Calwell, MD; K M Goel, MD, and others .............................. R J Hetherington, MB; Z B Tabara, FRCS. . 1082 Atropine or thymoxamine for chronic Practice in Canada asthma? J B Morison, MD ...................... 1083 E N Wardle, MD ...................... Impeccable syllable Factor VIII and chronic renal failure P J E Wilson, FRCS .................... 1083 Z M Ruggeri, MD, and others ..... ....... Fractures of the tibia Bromocriptine for severe mastalgia R Ger, FRCS . B V Palmer, FRCS, and J C M P Monteiro, ................ MD ................................. 1083 Alcoholic liver disease in women A N Hamlyn, MRCP .............. Bromocriptine for Cushing's disease SOMA A L Kennedy, MRCP, and D A D MontPhilippa MacLiesh .................... gomery, FRCP ........................ 1083 Staffing in the medical laboratory service F J Baker, FIMLS, and J K Fawcett, FCIS; I J Y Cook; R Holman, FIMLS; J C Giddings, PHD; L G Whitby, FRCP, and others .............................. 1081 Commitment to oncology .............. 1082 J Walter, FRCR .......... Breakfast and Crohn's disease
Correspondents are urged to write briefly so that readers may be offered as wide a selection of letters as possible. So many are being received that the omission of some is inevitable. Letters should be signed personally by all their authors. Staffing in the medical laboratory service
SIR,-Your leading article of (2 April, p 866) and recent correspondence (26 March, p 833) demonstrate that inferences going beyond what we stated and intended have been drawn from our policy document on staffingl and from our evidence2 to the Royal Comnuission on the National Health Service. These documents, contrary to the conclusion of Professor Whitby -and his colleagues, were widely distributed, the recipients including the Royal College of Pathologists, the Association of Clinical Biochemists, the Department of Health and Social Security, the Scottish Home and Health Department, and all regional scientific officers. We must reiterate that the institute did not deny pathologists their proper role in medical laboratories but decided that matters relating to medical staffing should be left to the medical profession. The tone of the criticism directed at us recently leaves little doubt that we would have been even more severely castigated if we had presumed to comment on medical staffing. As the leading article and correspondence raise many issues, we must confine ourselves merely to correcting some errors of fact. Both the article and the letter from Professor Whitby et al perpetuate the mistake of referring to graduates and technicians as if they were two different occupational classes, whereas "technician" describes someone designated in a certain way by the Whitley Council and "graduate" describes someone possessing a certain kind of qualification. Far from being mutually exclusive groups, most "graduate scientists" entering the medical laboratory service are being appointed as "technicians." This reflects a logical and inevitable evolutionary change which goes back over 20 years and is not, as Professor Whitby and colleagues suggested, merely "a reflection of the current economic situation." This institute has advocated for nearly 10 years that changes should be made in medical laboratory staffing to eliminate the confusion
Paracetamol-induced acute pancreatitis R A Coward, BM ...................... Therapeutic test with colchicine in diagnosis of gout 1084 P L Kinsella, MRCP .................. 1084 Interviewing women applicants Christine M Gaston, BM ......... I..... Increased university fees and graduate medical students 1084 D P Gradwell, BSC .................... Administrative staff in the NHS E J M Weaver, FRCS .................. 1085 Choice of BMA division C A K Bird, FRCPATH .................. 1085 Hospital practitioner anaesthetists: requirements for appointment 1085 D P V L Giles, MRCGP ................ BMA and medical indemnity 1085 W Gault, FRCOG ...................... Getting the contract right N H N Mills, MFCM .................. 1086 1084
1086
1086 1086 1086 1087
1087 1087 1087
1087
publish a letter from one of its own members because the writer criticised this staffing document, even to the conclusion of accepting readily that member's resignation. I therefore do not feel bound to defend the IMLS, who are apparently set on a suicidal course. However, many of us do feel obliged to reassure pathologists that the majority of senior chief and principal technicians have no clandestine plans of a coup d'etat in pathology -only a desire to participate in laboratory management for the benefit of the department and the service as a whole-a fact sadly ignored by HSC(IS)16 and undoubtedly a cause of much of the present unrest.
resulting from use of the term "technician." Your leading article proposed that the hospital scientific service might adopt a staff structure comparable with that in the Scientific Civil Service. That is just what we have been saying for years. The only difference is that you described the obsolete system prevailing before publication of the Fulton Report3 in 1968, as a consequence of which an integrated structure was introduced. The system for the nonI J Y COOK Principal Technician medical staff of medical laboratories must be brought into line with other forms of employ- Area Department of Pathology, ment, including the modem Scientific Civil Exeter Service. F J BAKER SIR,-In common with thousands of my President colleagues I have no objection to my consultant J K FAWCETT pathologist having "control of all the resources Secretary, Institute of Medical Laboratory Sciences of the laboratory" (2 April, p 866). What I do object to are the proposals put forward by London WI certain professional bodies which, as I see l Institute of Medical Laboratory Sciences, Future them, unfairly judge my 20 years of practical Staffing in the Medical Laboratory Service. A Policy experience (12 at a senior level) against even Statement. London, IMLS, 1976. 'Institute of Medical Laboratory Sciences, Etidence recently obtained higher academic qualificato the Royal Commission on the National Health tions. Service. London, IMLS, 1977. 'HM Treasury, Report of the Committee on the Civil I would respectfully suggest that a confusion Service 1966-68. HMSO, 1968. of terminology is in existence here-a conunon occurrence within hospital laboratories. Is not the consultant the director, and the chief SIR,-I suspect that many medical- laboratory technician the manager'? If it helps anyone's technicians will be equally incensed by the sensitivity I would always agree for technical institute's document "Future staffing in the to be appended to the latter title. Perhaps all Medical Laboratory Service" as Professor L G grades of medical laboratory staff could look Whitby and others were in their letters (26 closely at the sentiments expressed in Dr H A March, p 833). Many of the more senior Lee's letter (2 April, p 902) and remember that medical laboratory technicians were concemed the axiom "patients before politics" applies at that such a document would inevitably cause a local as well as national level. deterioration in the working relationships R HOLMAN between pathologists and technicians. No doubt Senior Chief Technician, Biochemistry Department many of the present institute council members have forgotten, or choose to forget, that the Bexley, Kent present status of medical laboratory technicians owes much to the co-operation and support, particularly in the past, of eminent pathologists. SIR,-Recent correspondence in the British It is also equally disturbing that the institute Medical J7ournal and the leading article has become so undemocratic that it refused to (2 April, p 866) focus on what appears to be a
