What’s your Job Title?
Medical Scientist, in Pathology.
In a nutshell, what do you do?
We receive and test samples from patients, to help the medical team understand what’s going on and enable them to treat someone appropriately.
Samples can be anything that is excreted (urine, faeces, sputum synovial fluid, or fluid out of a joint, for example), blood (the majority of what we test, at 60% – 70% of samples) or it can be body tissue. This might be tested for tumours, or removed due to inflammation, for example an appendix removed due to abdominal pain.
If you work in private Pathology labs, the samples come from GP patients; if you work in hospital Pathology labs, the samples come from hospital patients – quite a different population, as hospital patients are obviously quite ill and therefore samples are more varied.
Why did you decide to become a Medical Scientist (Pathology)?
I always knew that the human body intrigued me, so I tried to think about all the different areas of health that I could work in. I actually thought about Nursing as well, because I like people… but I always used to ask ‘why?’ a lot as a kid – why do things work that way, why do they fail, and why can’t we do things differently… The ‘why’ was really important to me, and Nursing’s more about ‘who’. Pathology is more of a ‘why’.
Pathology is more in the background, so you don’t actually get to meet patients – you do occasionally, particularly if you get out to bleed them, but not every day, and if you’re a Scientist in the Lab, you don’t get to bleed patients very often.
It’s a really interesting field, you’re highly regarded in the Hospital environment and you work as part of a very large Medical team. It’s mostly in the background – so it wouldn’t appeal to someone who wants to be involved, face-to-face, with patients all the time – but you do need good team skills, as you work in the same Lab with the same people, every day, 5 days a week. Good communication is absolutely essential.
What path did you take into it?
I trained in England, so it’s a bit different there. I entered the Pathology Lab when I was 17 and effectively did a kind of apprenticeship, working in each discipline of Pathology, ie. Haematology, Transfusion, Microbiology, Clinical Chemistry, Histopathology (working with tissues,) and Immunology. I worked as a Junior in each of these areas, getting a grounding, and then specialised in Haematology and Transfusion,.
In Australia, you have 2 routes, depending on what level you want to work at. To start with, you can do an Associate Degree which will allow you to work as a Technician in the Laboratory (an HP2, in the Hospital setting). To become a Medical Scientist, you need a Medical Laboratory Science degree; It cannot be a Biomedical Laboratory Science degree, because you need the Clinical units that go with the disciplines – Haematology, Blood Transfusion, Microbiology, Clinical Chemistry, Histopathology and Immunology.
The Associate degree is embedded in the full undergraduate degree, so if you enroll to study a Medical Science degree, you can exit early and leave with an Associate Degree, enabling you to work as a Technician. Or, if you do an Associate degree, you can start as a Technician and then upskill into Medical Science, by completing a further year at University (NB this may become 2 years in the future).
Finally, if you want to work in a support role in a Lab, helping with administration – checking IDs, preparing samples for testing, entering patient information into the database – you can apply for a job as an Operations Officer (in private labs, this role is called Lab Assistant). To work in this field, you don’t necessarily need qualifications, just a high attention to detail (though having, for example, a Certificate III in Pathology may help you to secure a role).
What, in your opinion, is the best bit of being a Medical Scientist (Pathology)?
Once you’re capable and competent, the best bit of working in a Hospital Pathology Lab is when you’re working midnight ‘til dawn and you get a really challenging case; one that needs a lot of blood for transfusion is always challenging.
So a trauma comes in through Emergency, and the nurse stands at the door and shouts ‘I need 2 units of O Negative blood, now’, and she’s panicking. The trick is to calm her down, give her what she needs, get the specimens and work as fast as you possibly can, keeping on top of what you’re doing, so that at the end of the day, the patient survives and you’ve done everything you have to do, to make sure that that happens.
That would include doing the full blood count (which allows them to identify how much blood loss they’ve had), the clinical chemistry, to make sure that the fluid balances are right and they have not had a heart attack etc. and to get blood out to the patient if they are bleeding.
Once you’ve done that, on your own, at 2 O’Clock in the morning, the adrenaline pumps and it is really rewarding – even though you don’t see the patient, and even though people don’t often say thank you. At the end of it, you’re really satisfied. Or at 2 O’clock in the morning when the Analyser’s broken down, the computer system’s not working, and you’ve got a Trauma in Emergency… at the end of the shift you’re exhausted, but you feel fantastic.
The other thing I really enjoy, even being in a Lab where I’m working on the bench and the systems are working, I actually enjoy it when the computer goes down; I’m a systems person. I like organising a different work-flow and I love the fact that it works, that I know where everything is. Obviously we’re working with lots and lots of specimens – we don’t just do one patient at a time – but I know how to make it work. I know that I’m doing the best I possibly can, and even though you’re exhausted at the end of it, you feel really exhilarated.
I run on adrenaline, and that’s why I love Transfusion. You can specialise in the different disciplines; Haematology is looking down the microscope at blood films, as well as using Analysers (computerised testing machines)… and so is Blood Transfusion, but even with an Analyser identifying the blood types, you still have to make the decision that the blood is compatible.
90% of the time the results are normal – or they’re ‘normal’ for that patient and you understand what the results are and why you’re getting them – but 10% of the time you get challenging results and have no idea what’s going on so you use your knowledge and work it out.
I still get excited when I see a bag of blood, or when I find a new leukaemia; I know that’s sad, when a new leukaemia comes in and you get excited, because you’ve helped to diagnose it… You think, that’s someone’s life that’s changing now. But it’s about the patient and it’s about making a difference – about allowing the medical staff to diagnose the patient – and when you are part of that team and have done your job well, then the patient gets the best care.
Highlights are when I’ve had a patient come back – and in 30 years, there’s been perhaps 3 patients who’ve come back to the lab to say thank you – but those are the ones that you think, wow, they’ve noticed that you were there. It makes a real difference.
Every job has its downsides. What do you think are the worst bits?
I think Private Pathology has a higher number of routine specimens, because they’re more standard GP specimens – they do have their abnormals, but less variety than a typical Hospital environment. Having said that, private Pathology labs hire highly trained, professional people and have very high ethical standards as we do in the public system in Queensland.
Over the years, pathology has become much more automated – we’ve moved from doing manual tests to putting specimens on Analysers, and pressing buttons – and it’s becoming more so. That’s fine, because you’ve still got to get your Analyser working and these are $300, 000 machines, so they’re quite technical. But while you do things manually at University, the practical side of things is different in the Lab, where it’s highly automated. Things don’t take as long, but it can take some of the joy out.
Having said that, some of the stuff that goes on behind the ‘black box’ – the stuff that you learn at University and you think you’ll never need it – trust me, you do need it. I like to know, when I’m interviewing for new Scientists, do they understand why and how you measure glucose – not just knowing what glucose is, and that you put it on an Analyser and press a button. They need to know what reaction is happening in that machine, so that when it breaks down and they have to fix it, they understand what’s going on and why.
Finally, remember that this is a 24/7, 7 days a week job – you do night shifts and you might work 8.00 – 4.00 on Christmas day. If you don’t want to work in a 24/7, 7 days a week, 365 days a year job, then don’t pick Pathology, because people get sick all the time. Depending on where you work, private labs might be a little bit better, with more flexibility – but they still work midnight ‘til dawn.
Generally, in private labs, there won’t be as many people working overnight shifts, because people stop going to their GPs earlier, so specimens typically hit the private labs up ‘til 9.00 or 10.00 at night, and then they trail off. They tend to have Stat labs, which absorb all the GP work that comes in overnight.
By contrast, in the public health system, you have Emergency Departments running 24/7 with people walking in all the time. Fridays and Saturday nights are probably your busiest times.
Is it what you expected when you first started out – and what’s different?
I love it – I still love it, and I’ve been working in it for a long, long time. People always underestimate it…
It has changed over the years, particularly with the introduction of automation, as well as budgetary constraints. In public health, we’re restrained by budgets now where at one time everyone thought health was free and we just did what we needed to do. Now we have budgets that we need to stick to, and that’s hard – we do more with less, and we’ve got less people than we had before – but I still love it.
What do the public least understand – or mistake – about what you do?
They go to the GP and they have some blood taken… but they don’t understand the complexity of it. The number of tests that we do is printed in a little book that’s half an inch thick, and the font’s a size 10; there’s 20 tests to a page, and there’s maybe 300 pages. We may not know every single test, but we need to understand the concept of all of them. The general public don’t understand any of that – they don’t have to, that’s what we’re for.
People think they can get an answer instantly. They watch forensic science programs and medical drama on TV, where someone in the trauma team says ‘I want 3 units of O Neg, stat’ and then someone runs in with a bag of blood… it doesn’t happen like that, it takes time.
If someone wants the result from a tissue sample, it typically takes 3 – 4 days to get a result and that’s not much you can do about that. You have to fix the tissue before you can test it – you have to process it to fix it – and that takes time. The programs on TV don’t help.
Some of the Allied Health staff don’t realise what goes on in Pathology – probably because they have just never had the opportunity to come and see for themselves – and they’re always amazed when they come and have a look.
What kind of people tend to do well?
People with a high attention to detail; every single specimen that comes in is checked 3 or 4 times, before it goes out, and that’s if everything’s normal. It’s checked when it comes in, it’s checked when it goes on the Analyser, it’s checked before it goes out… and we do more than 10 million tests every year.
You also need the ability to think, and work in a highly logical, systematic manner. If your Analyser’s broken, you need to fix it and you have to go through step-by-step, logically – you can’t just pull it apart and have a look.
You’ve got to have good team-work skills, to be able to communicate well, because you’re in a high performing team. If you want to sit in a corner and do your own tests, that’s not what we need – we need people who can communicate effectively with others.
When we’re interviewing, I go for the person. I want someone who’s energetic and enthusiastic; if they get excited when we’re talking about the work, then they get a big tick from me. I need them to be able to work quickly – multi-tasking is a big deal, as you’re often doing multiple things whilst you’re working in the Lab. Some of the more specialised labs require you to be very focused on the task for example in a specialist Genetics Lab; these labs require the staff to be highly skilled in one area of pathology
In the interview, I’ll look for attention to detail – I’ll do something like put PTO on the bottom of the question sheet, and sometimes people don’t read it and miss the other question on the back. If they do, it’s not the end of the world, but then they’ll need to think on their feet when they answer the question.
I want to see someone being very logical and systematic. If I ask someone to tell me what they’d do in a scenario, I don’t want them giving me thought processes off the top of their head – I might do this, or I might do that… They’ve got to take a deep breath, think ‘what would I do in this instance?’, start at the very beginning and go right to the end, taking me through the process, step-by-step.
Finally, any advice you’d offer to people looking to get into this line of work?
Make sure you do the right qualification! I have so many people who ring up looking for work, saying that they’ve done Bio-Med – and they need to have done Medical Science. For some roles we put our new staff through a 14 week, condensed ‘boot camp’, program, to make sure that they’re competent in all the areas – but we can’t do that if they don’t have the right foundation knowledge to start with.
They need to have covered all the main areas of Pathology to be multi-skilled, which is the core of what we do in our labs. Sometimes these core areas are electives, but you need to have done each one of them to be multi-skilled. The core areas are:
Haematology – analysing whole blood counting white cells, red cells and measuring haemoglobin, also looking at blood films for anaemias and leukemias
Clinical Biochemistry – testing the plasma or serum of the blood for lots of analytes eg: sodium, potassium chloride, urea, electrolytes (liver and kidney function)
Blood Transfusion – essential if you’re ever going to work rural or remote, as it’s time-critical work
Microbiology – looking at patients with infections, monitoring what grows from specimens in culture (often centralised to larger labs)
Histopathology? processing tissue removed from patients and testing for tumours, infection etc
If you’ve done Bio-Med, it’s not the end of the world, you just need to get those Clinical units before you can work in a Pathology lab. You need to go back to Uni, tell them what you’ve done already and ask how they can help you to get those additional units; as an add-on, it’ll typically take about a year and a half.
I see that as a positive – someone’s not given up when they’ve realised they’ve done the wrong studies… they’re asked, what do I need to do and they’ve gone on and done it. It shows real commitment.
Alternatively, if someone doesn’t want to take on additional units, they can apply to work as an Operational Officer (in private Pathology labs, a Lab Assistant), checking IDs, packing eskys, preparing samples for testing, entering data into the computer system. It’s a support role for those working in the lab.
Another completely different area is Forensic Science, it’s very specialised and you’re working with criminal cases, typically with people who are deceased or waiting to go to court, so the time is not as critical, and you may be helping with a case that’s been closed for a long time. Accuracy is essential in this role and highly trained (and educated) staff work in forensic science.
There are lots of people studying Forensics (probably because of the way it’s portrayed on TV, which isn’t realistic at all) but there are very, very few jobs in it. In Queensland, there’s only one site that performs Forensic tests, and even though my niece has a Masters in Forensic Science and she teaches Forensic Science at University, she’s not been able to get a job in it.