Re: [Histonet] RE: Qualifications for grossing
Wow .I am appalled with these threads. There are many of us in our field who have grown up in hospital settings learning real time Histotechnolgy and not by books. Sitting bedside with patients speaking with their loved ones. Let's respect this and move on to other topics that challenge us present day in our fields... Regards to ALL of us in our field Candace Connected by DROID on Verizon Wireless -Original message- From: Jay Lundgren To: Nicole Tatum Cc: histonet@lists.utsouthwestern.edu Sent: Thu, Apr 26, 2012 01:43:38 GMT+00:00 Subject: Re: [Histonet] RE: Qualifications for grossing I agree with Renee's post completely. When the motivation is greed, and not patient care, we, as laboratory professionals, should be concerned. I think we should all realize that the regulations are there to protect ALL of our livelihoods, HTs, PAs, MDs, HTLs, and everyone who works in the lab. Patients (insurance companies, the Federal government) would not pay for testing anymore if the results were invalid. If I were a Histology Superintendent thinking of having an under trained laboratory aide do immunohistochemistry, or gross: Could you get away with it?: Sure. Save $40,000. / year per HTL you replace, more if PA. Would you want that to be your specimen? : No. What would one nasty malpractice lawsuit cost your facility?: Potentially multi-millions of dollars. Hiring unqualified techs is false economy. Reimburse your lab aides for tuition if you want them to do high complexity testing. Apologies to any lab aides with PhDs, or any 6th grade dropouts with 30 years of X-ray Crystallography and Proteomics bench experience. Sincerely, Jay A. Lundgren, M.S., HTL (ASCP) ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] RE: Qualifications for grossing
I agree with Renee's post completely. When the motivation is greed, and not patient care, we, as laboratory professionals, should be concerned. I think we should all realize that the regulations are there to protect ALL of our livelihoods, HTs, PAs, MDs, HTLs, and everyone who works in the lab. Patients (insurance companies, the Federal government) would not pay for testing anymore if the results were invalid. If I were a Histology Superintendent thinking of having an under trained laboratory aide do immunohistochemistry, or gross: Could you get away with it?: Sure. Save $40,000. / year per HTL you replace, more if PA. Would you want that to be your specimen? : No. What would one nasty malpractice lawsuit cost your facility?: Potentially multi-millions of dollars. Hiring unqualified techs is false economy. Reimburse your lab aides for tuition if you want them to do high complexity testing. Apologies to any lab aides with PhDs, or any 6th grade dropouts with 30 years of X-ray Crystallography and Proteomics bench experience. Sincerely, Jay A. Lundgren, M.S., HTL (ASCP) ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] RE: Qualifications for grossing
>Im sorry you feel that way about me. There is nothing snide here. I respect your opinion and have no foul words for you. Im happy that you have earned your education. I currently am in school trying to further mine, and I belive an education is so important. To a person and a profession. Have a wonderful day. Nicole Tatum, HT ASCP Try to keep your snide remarks quiet, and respond with some degree of > respect. We will not always agree, but there is no "strike" there. You > dislike me,, that's fine. But keep your personal comments to yourself. > If you can be that mature. > > Sent from my Windows Phone > From: Nicole Tatum > Sent: 4/25/2012 12:09 PM > To: Joanne Clark; histonet@lists.utsouthwestern.edu > Subject: Re: [Histonet] RE: Qualifications for grossing > Yupp he strikes again. > > > Joanne, > > I strongly agree with your perspective. Many Techs do not have formal > expensive educations and have sat on the bench for many years and > eventually became grandfathered in. Those techs are the life blood of > pathology. It has only been in recent years that licensure has become a > larger part of health care requiring personal to obtain certification to > "hopefully" increase patient care. But, this argument is becoming a thing > of the past, because CLIA, CAP, JOCA have set standards that personal must > meet regardless of the extensive OJT. I am qualified to gross based on > these accrediators standards. It is others opinions that think these > "standards" are weak. If the argument is greed, than people should > understand that employee payroll is the highest cost within a laboratory > so to help cut cost to our bankrupt health care system, why not pay a > Histologist who is clearly qualified to do a job they have been doing > since the beginning of pathology. > > > The pathologists assistant profession began in 1969 with a pilot training > program at the Veterans Administration Medical Center (VAMC) in Durham, > North Carolina. > > In 1856 William Perkin discovered the dye mauve that was used in the early > 1860s by F W B Benke of Marlbery. Joseph Janavier Woodward, a surgeon in > the US Army, used fuchsine and aniline blue to stain human intestines. > Paul Ehrlich realized that the chemical dyes obtained from coal tar did > not simply color cells but combined with the chemical elements within them > to form new substances. The Swiss chemist Friedrich Miescher, in 1869 used > aniline dyes to examine the cell nucleus. In 1875 Carl Weigart, Ehrlich's > cousin, demonstrated the fuchsine derivative methyl violet stained > bacteria as opposed to tissue. > > The first histologist, Marcello Malpighi (1628-1694), an Italian > anatomist, is in fact considered the true Father of Histology. > > 1819, A. Mayer created the term Histology. In the sequence of the previous > word tissue, made use of two classical Greek root words (histos = tissue > and logos = study > > So, my point is I do believe Histo's have been involved since the very > beginning. We as a profession have a combined experience well beyond that > of any formal education. > > Last thought, and I quote, "I know I would make mistakes, and mistakes may > be considered part of the learning process, but do we really want to > accept that in health care? Mistakes should happen in school, not with a > real, live patients tissue." > > This statement clearly conflicts with all aspect of becoming a medical > professional. Our state/government funded hospitals employ thousands of > residents each year who treat thousands of indigent and paying patients. > This is their school. Histologist do interships within hospitals to get > training. This is their school to. Nurses, MLT's, MA's, everyone in health > care learns the actual (beyond books)trade from watching and working with > skilled persons who have many years of experience. They would not place a > student with a person who has a degree but no experience. My education > qualifies me to be trained by anyone in my field of pathology, and I > should be used where my skills will best serve my department and increase > patient care. Each one of us serves a purpose and is valuable, no matter > what job we perform with what amount of education. The law is weeding out > those who are no longer qualified to work in out field, they set the > standard. Let's let them make the decisions on who is qualified to do what > and stick together to ensure its fair to each one of us. > > Can't we all just get along...hehehehehe > > Nicole Tatum HT, ASCP > > > > > > > > ___ > Histonet mailing list > Histonet@lists.utsouthwestern.edu > http://lists.utsouthwestern.edu/mailman/listinfo/histonet > ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] RE: Qualifications for grossing
Thank you Hazel. Sent from my Windows Phone From: Horn, Hazel V Sent: 4/25/2012 12:18 PM To: Davide Costanzo; Joanne Clark Cc: histonet@lists.utsouthwestern.edu Subject: RE: [Histonet] RE: Qualifications for grossing Well said. Hazel Horn Supervisor of Histology/Autopsy/Transcription Anatomic Pathology Arkansas Children's Hospital 1 Children's Way | Slot 820| Little Rock, AR 72202 501.364.4240 direct | 501.364.1302 office | 501.364.1241 fax hor...@archildrens.org archildrens.org 100 YEARS YOUNG! JOIN THE PARTY AT ach100.org -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Davide Costanzo Sent: Wednesday, April 25, 2012 11:34 AM To: Joanne Clark Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] RE: Qualifications for grossing Joanna, I wanted to take an opportunity to explain my, and most of my colleagues, feelings about CLIA '88 with respect to grossing standards. But I want to start by stating that this goes both ways, I also do not feel it is appropriate for an ASCP certified PA to be performing Immunohistochemistry, or other stains in the lab. Both histotechnicians (ologists) and PA's have a very clear role in the pathology laboratory. Both have very different training programs. Both HT's and PA's should be protected by law, and rules/regulations for each should be clear. One is not better than the other, and I certainly hope you do not think I have an opinion different from that. Both are highly qualified individuals in their area of expertise. In many states, and I will use Florida as an example because that is what I am familiar with, there are clear definitions in the law as to whom can perform what tasks. In the State of Florida, a PA (regardless of training level) is not to perform frozen sections. That State only allows Pathologists and HT's to cut a frozen. This is the result of much effort put in to changing those rules by the HT's in Florida. Clearly they saw PA's as a threat to their job, and took action. Not a problem, I am happy to let them do the frozen sections. What was it about cutting a frozen section that the HT's thought a PA could not handle? I do not know, but nonetheless they reacted. Certainly PA's are heavily trained in how to cut a frozen section, and it is generally considered our responsibility in most places in the US that I have seen, and I have seen many. Rarely, outside the State of Florida, do I see PA's that do not cut frozens. Now, on to the issue of grossing techs. There are myriad reasons why I, and most of my peers, think it is not appropriate to utilize "grossing techs". For starters, and to be clear, the use of such techs serves one principal purpose to the pathologist's and institutions that employ them - to save money and increase their profits. They are not employed because they represent the clear choice for the utmost in patient care, and to suggest that is not just misleading, but completely false. Grossing small specimens is never just about transferring tissue from a container to a block. Many tend to try and downplay the importance of that task, and overlook things that could be problematic without certain training/skills. And, there are many grossing techs that do larger cases, from gallbladders all the way up to mastectomies and beyond - all with no didactic education, no proficiency testing and no rotations through various types of insitutions. I have never seen a study, but perhaps someone on here has, that points out the sharp increase in error rates found when a tech is used to gross, versus a trained pathologists' assistant. There is a drastic difference. It is distinct, and a study is really not needed to see that difference. Now, to be clear again, that is not to say that every tech that grosses does a bad job. No "vitriol" here. It is just a fact, and a troubling one at that. Imagine the difference in quality you would see if you had me doing all your stains! I am not trained as an HT. You could argue that I could be trained, but do you really want to open that can of worms? Do you want medicine to allow for that, and risk the HT profession? Probably not, and we do not either. Do you think I would be as good as you are, given all the real education you received when getting your HT training? I don't think I would be as good as you are at doing your job. As an example to illustrate, anyone that grosses should know how to answer these very basic questions. These might help shed some light on the issue: 1. What is the most common neoplasm of the gallbladder, what does it look like, and where is it found? Would you know it if you saw it? Is it benign, or malignant? 2. What is the reason that all appendices should have the margin submitted in the initial submission? 3. Would you know the difference between an esophagea
RE: [Histonet] RE: Qualifications for grossing
Well said. Hazel Horn Supervisor of Histology/Autopsy/Transcription Anatomic Pathology Arkansas Children's Hospital 1 Children's Way | Slot 820| Little Rock, AR 72202 501.364.4240 direct | 501.364.1302 office | 501.364.1241 fax hor...@archildrens.org archildrens.org 100 YEARS YOUNG! JOIN THE PARTY AT ach100.org -Original Message- From: histonet-boun...@lists.utsouthwestern.edu [mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Davide Costanzo Sent: Wednesday, April 25, 2012 11:34 AM To: Joanne Clark Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] RE: Qualifications for grossing Joanna, I wanted to take an opportunity to explain my, and most of my colleagues, feelings about CLIA '88 with respect to grossing standards. But I want to start by stating that this goes both ways, I also do not feel it is appropriate for an ASCP certified PA to be performing Immunohistochemistry, or other stains in the lab. Both histotechnicians (ologists) and PA's have a very clear role in the pathology laboratory. Both have very different training programs. Both HT's and PA's should be protected by law, and rules/regulations for each should be clear. One is not better than the other, and I certainly hope you do not think I have an opinion different from that. Both are highly qualified individuals in their area of expertise. In many states, and I will use Florida as an example because that is what I am familiar with, there are clear definitions in the law as to whom can perform what tasks. In the State of Florida, a PA (regardless of training level) is not to perform frozen sections. That State only allows Pathologists and HT's to cut a frozen. This is the result of much effort put in to changing those rules by the HT's in Florida. Clearly they saw PA's as a threat to their job, and took action. Not a problem, I am happy to let them do the frozen sections. What was it about cutting a frozen section that the HT's thought a PA could not handle? I do not know, but nonetheless they reacted. Certainly PA's are heavily trained in how to cut a frozen section, and it is generally considered our responsibility in most places in the US that I have seen, and I have seen many. Rarely, outside the State of Florida, do I see PA's that do not cut frozens. Now, on to the issue of grossing techs. There are myriad reasons why I, and most of my peers, think it is not appropriate to utilize "grossing techs". For starters, and to be clear, the use of such techs serves one principal purpose to the pathologist's and institutions that employ them - to save money and increase their profits. They are not employed because they represent the clear choice for the utmost in patient care, and to suggest that is not just misleading, but completely false. Grossing small specimens is never just about transferring tissue from a container to a block. Many tend to try and downplay the importance of that task, and overlook things that could be problematic without certain training/skills. And, there are many grossing techs that do larger cases, from gallbladders all the way up to mastectomies and beyond - all with no didactic education, no proficiency testing and no rotations through various types of insitutions. I have never seen a study, but perhaps someone on here has, that points out the sharp increase in error rates found when a tech is used to gross, versus a trained pathologists' assistant. There is a drastic difference. It is distinct, and a study is really not needed to see that difference. Now, to be clear again, that is not to say that every tech that grosses does a bad job. No "vitriol" here. It is just a fact, and a troubling one at that. Imagine the difference in quality you would see if you had me doing all your stains! I am not trained as an HT. You could argue that I could be trained, but do you really want to open that can of worms? Do you want medicine to allow for that, and risk the HT profession? Probably not, and we do not either. Do you think I would be as good as you are, given all the real education you received when getting your HT training? I don't think I would be as good as you are at doing your job. As an example to illustrate, anyone that grosses should know how to answer these very basic questions. These might help shed some light on the issue: 1. What is the most common neoplasm of the gallbladder, what does it look like, and where is it found? Would you know it if you saw it? Is it benign, or malignant? 2. What is the reason that all appendices should have the margin submitted in the initial submission? 3. Would you know the difference between an esophageal bx and a bx from any other part of the GI tract simply by gross appearance? What would you do if you had 2 specimens, one esophagus and one duodenal and they were
Re: [Histonet] RE: Qualifications for grossing
Yupp he strikes again. Joanne, I strongly agree with your perspective. Many Techs do not have formal expensive educations and have sat on the bench for many years and eventually became grandfathered in. Those techs are the life blood of pathology. It has only been in recent years that licensure has become a larger part of health care requiring personal to obtain certification to "hopefully" increase patient care. But, this argument is becoming a thing of the past, because CLIA, CAP, JOCA have set standards that personal must meet regardless of the extensive OJT. I am qualified to gross based on these accrediators standards. It is others opinions that think these "standards" are weak. If the argument is greed, than people should understand that employee payroll is the highest cost within a laboratory so to help cut cost to our bankrupt health care system, why not pay a Histologist who is clearly qualified to do a job they have been doing since the beginning of pathology. The pathologists assistant profession began in 1969 with a pilot training program at the Veterans Administration Medical Center (VAMC) in Durham, North Carolina. In 1856 William Perkin discovered the dye mauve that was used in the early 1860s by F W B Benke of Marlbery. Joseph Janavier Woodward, a surgeon in the US Army, used fuchsine and aniline blue to stain human intestines. Paul Ehrlich realized that the chemical dyes obtained from coal tar did not simply color cells but combined with the chemical elements within them to form new substances. The Swiss chemist Friedrich Miescher, in 1869 used aniline dyes to examine the cell nucleus. In 1875 Carl Weigart, Ehrlich's cousin, demonstrated the fuchsine derivative methyl violet stained bacteria as opposed to tissue. The first histologist, Marcello Malpighi (1628-1694), an Italian anatomist, is in fact considered the true Father of Histology. 1819, A. Mayer created the term Histology. In the sequence of the previous word tissue, made use of two classical Greek root words (histos = tissue and logos = study So, my point is I do believe Histo's have been involved since the very beginning. We as a profession have a combined experience well beyond that of any formal education. Last thought, and I quote, "I know I would make mistakes, and mistakes may be considered part of the learning process, but do we really want to accept that in health care? Mistakes should happen in school, not with a real, live patients tissue." This statement clearly conflicts with all aspect of becoming a medical professional. Our state/government funded hospitals employ thousands of residents each year who treat thousands of indigent and paying patients. This is their school. Histologist do interships within hospitals to get training. This is their school to. Nurses, MLT's, MA's, everyone in health care learns the actual (beyond books)trade from watching and working with skilled persons who have many years of experience. They would not place a student with a person who has a degree but no experience. My education qualifies me to be trained by anyone in my field of pathology, and I should be used where my skills will best serve my department and increase patient care. Each one of us serves a purpose and is valuable, no matter what job we perform with what amount of education. The law is weeding out those who are no longer qualified to work in out field, they set the standard. Let's let them make the decisions on who is qualified to do what and stick together to ensure its fair to each one of us. Can't we all just get along...hehehehehe Nicole Tatum HT, ASCP ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] RE: Qualifications for grossing
Nothing is black and white. Perhaps exceptions are in order where the tech only does one specimen type. Perhaps. But not where techs do a lot more. There are gross techs out there doing colons, mastectomies etc. This is where big trouble brews. This is where people are not adequately trained, by NAACLS standards. CLIA '88 is the problem, not the tech. CLIA is over 20 years old, and at that time PA's were fairly new on the scene and in short supply. That is not the case today. It is time to raise the bar and improve patient care. There are no valid excuses. Today, this is no more than financial greed that accounts for misuse of personnel. Sent from my Windows Phone From: Ingles Claire Sent: 4/25/2012 10:43 AM To: Rene J Buesa; Joanne Clark; Davide Costanzo Cc: histonet@lists.utsouthwestern.edu Subject: RE: [Histonet] RE: Qualifications for grossing You can reprocess, recut, and restain, but never re-gross. I for one also gross, but only skin. And yes, I DO know how to gross an alopecia specimen. Claire From: histonet-boun...@lists.utsouthwestern.edu on behalf of Rene J Buesa Sent: Wed 4/25/2012 11:55 AM To: Joanne Clark; Davide Costanzo Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] RE: Qualifications for grossing For what little it may mean, I wholeheartly agree with Davice Costanzo e-mail. I completely agree with him. In the same way the economic situation we are now was caused by greed, that is the motor guiding those who, to just save money, let a histotech (ologist) to do grossing. Grossing,, especially large complex specimens, is the fundamental initial task in any complex diagnosis. The PA is the one who SELECTS what is going to be processed and used for diagnosis. IF some part of the specimen is not submitted as the result of ignorance caused by poor training, the worst thing could happen, namely, a FALSE NEGATIVE --- On Wed, 4/25/12, Davide Costanzo wrote: ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
RE: [Histonet] RE: Qualifications for grossing
You can reprocess, recut, and restain, but never re-gross. I for one also gross, but only skin. And yes, I DO know how to gross an alopecia specimen. Claire From: histonet-boun...@lists.utsouthwestern.edu on behalf of Rene J Buesa Sent: Wed 4/25/2012 11:55 AM To: Joanne Clark; Davide Costanzo Cc: histonet@lists.utsouthwestern.edu Subject: Re: [Histonet] RE: Qualifications for grossing For what little it may mean, I wholeheartly agree with Davice Costanzo e-mail. I completely agree with him. In the same way the economic situation we are now was caused by greed, that is the motor guiding those who, to just save money, let a histotech (ologist) to do grossing. Grossing,, especially large complex specimens, is the fundamental initial task in any complex diagnosis. The PA is the one who SELECTS what is going to be processed and used for diagnosis. IF some part of the specimen is not submitted as the result of ignorance caused by poor training, the worst thing could happen, namely, a FALSE NEGATIVE --- On Wed, 4/25/12, Davide Costanzo wrote: ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
Re: [Histonet] RE: Qualifications for grossing
For what little it may mean, I wholeheartly agree with Davice Costanzo e-mail. I completely agree with him. In the same way the economic situation we are now was caused by greed, that is the motor guiding those who, to just save money, let a histotech (ologist) to do grossing. Grossing,, especially large complex specimens, is the fundamental initial task in any complex diagnosis. The PA is the one who SELECTS what is going to be processed and used for diagnosis. IF some part of the specimen is not submitted as the result of ignorance caused by poor training, the worst thing could happen, namely, a FALSE NEGATIVE --- On Wed, 4/25/12, Davide Costanzo wrote: From: Davide Costanzo Subject: Re: [Histonet] RE: Qualifications for grossing To: "Joanne Clark" Cc: "histonet@lists.utsouthwestern.edu" Date: Wednesday, April 25, 2012, 12:34 PM Joanna, I wanted to take an opportunity to explain my, and most of my colleagues, feelings about CLIA '88 with respect to grossing standards. But I want to start by stating that this goes both ways, I also do not feel it is appropriate for an ASCP certified PA to be performing Immunohistochemistry, or other stains in the lab. Both histotechnicians (ologists) and PA's have a very clear role in the pathology laboratory. Both have very different training programs. Both HT's and PA's should be protected by law, and rules/regulations for each should be clear. One is not better than the other, and I certainly hope you do not think I have an opinion different from that. Both are highly qualified individuals in their area of expertise. In many states, and I will use Florida as an example because that is what I am familiar with, there are clear definitions in the law as to whom can perform what tasks. In the State of Florida, a PA (regardless of training level) is not to perform frozen sections. That State only allows Pathologists and HT's to cut a frozen. This is the result of much effort put in to changing those rules by the HT's in Florida. Clearly they saw PA's as a threat to their job, and took action. Not a problem, I am happy to let them do the frozen sections. What was it about cutting a frozen section that the HT's thought a PA could not handle? I do not know, but nonetheless they reacted. Certainly PA's are heavily trained in how to cut a frozen section, and it is generally considered our responsibility in most places in the US that I have seen, and I have seen many. Rarely, outside the State of Florida, do I see PA's that do not cut frozens. Now, on to the issue of grossing techs. There are myriad reasons why I, and most of my peers, think it is not appropriate to utilize "grossing techs". For starters, and to be clear, the use of such techs serves one principal purpose to the pathologist's and institutions that employ them - to save money and increase their profits. They are not employed because they represent the clear choice for the utmost in patient care, and to suggest that is not just misleading, but completely false. Grossing small specimens is never just about transferring tissue from a container to a block. Many tend to try and downplay the importance of that task, and overlook things that could be problematic without certain training/skills. And, there are many grossing techs that do larger cases, from gallbladders all the way up to mastectomies and beyond - all with no didactic education, no proficiency testing and no rotations through various types of insitutions. I have never seen a study, but perhaps someone on here has, that points out the sharp increase in error rates found when a tech is used to gross, versus a trained pathologists' assistant. There is a drastic difference. It is distinct, and a study is really not needed to see that difference. Now, to be clear again, that is not to say that every tech that grosses does a bad job. No "vitriol" here. It is just a fact, and a troubling one at that. Imagine the difference in quality you would see if you had me doing all your stains! I am not trained as an HT. You could argue that I could be trained, but do you really want to open that can of worms? Do you want medicine to allow for that, and risk the HT profession? Probably not, and we do not either. Do you think I would be as good as you are, given all the real education you received when getting your HT training? I don't think I would be as good as you are at doing your job. As an example to illustrate, anyone that grosses should know how to answer these very basic questions. These might help shed some light on the issue: 1. What is the most common neoplasm of the gallbladder, what does it look like, and where is it found? Would you know it if you saw it? Is it benign, or malignant? 2. What is the reason that all appendices should have the margin submitted in the initial submission? 3. Would you know the diffe
Re: [Histonet] RE: Qualifications for grossing
Joanna, I wanted to take an opportunity to explain my, and most of my colleagues, feelings about CLIA '88 with respect to grossing standards. But I want to start by stating that this goes both ways, I also do not feel it is appropriate for an ASCP certified PA to be performing Immunohistochemistry, or other stains in the lab. Both histotechnicians (ologists) and PA's have a very clear role in the pathology laboratory. Both have very different training programs. Both HT's and PA's should be protected by law, and rules/regulations for each should be clear. One is not better than the other, and I certainly hope you do not think I have an opinion different from that. Both are highly qualified individuals in their area of expertise. In many states, and I will use Florida as an example because that is what I am familiar with, there are clear definitions in the law as to whom can perform what tasks. In the State of Florida, a PA (regardless of training level) is not to perform frozen sections. That State only allows Pathologists and HT's to cut a frozen. This is the result of much effort put in to changing those rules by the HT's in Florida. Clearly they saw PA's as a threat to their job, and took action. Not a problem, I am happy to let them do the frozen sections. What was it about cutting a frozen section that the HT's thought a PA could not handle? I do not know, but nonetheless they reacted. Certainly PA's are heavily trained in how to cut a frozen section, and it is generally considered our responsibility in most places in the US that I have seen, and I have seen many. Rarely, outside the State of Florida, do I see PA's that do not cut frozens. Now, on to the issue of grossing techs. There are myriad reasons why I, and most of my peers, think it is not appropriate to utilize "grossing techs". For starters, and to be clear, the use of such techs serves one principal purpose to the pathologist's and institutions that employ them - to save money and increase their profits. They are not employed because they represent the clear choice for the utmost in patient care, and to suggest that is not just misleading, but completely false. Grossing small specimens is never just about transferring tissue from a container to a block. Many tend to try and downplay the importance of that task, and overlook things that could be problematic without certain training/skills. And, there are many grossing techs that do larger cases, from gallbladders all the way up to mastectomies and beyond - all with no didactic education, no proficiency testing and no rotations through various types of insitutions. I have never seen a study, but perhaps someone on here has, that points out the sharp increase in error rates found when a tech is used to gross, versus a trained pathologists' assistant. There is a drastic difference. It is distinct, and a study is really not needed to see that difference. Now, to be clear again, that is not to say that every tech that grosses does a bad job. No "vitriol" here. It is just a fact, and a troubling one at that. Imagine the difference in quality you would see if you had me doing all your stains! I am not trained as an HT. You could argue that I could be trained, but do you really want to open that can of worms? Do you want medicine to allow for that, and risk the HT profession? Probably not, and we do not either. Do you think I would be as good as you are, given all the real education you received when getting your HT training? I don't think I would be as good as you are at doing your job. As an example to illustrate, anyone that grosses should know how to answer these very basic questions. These might help shed some light on the issue: 1. What is the most common neoplasm of the gallbladder, what does it look like, and where is it found? Would you know it if you saw it? Is it benign, or malignant? 2. What is the reason that all appendices should have the margin submitted in the initial submission? 3. Would you know the difference between an esophageal bx and a bx from any other part of the GI tract simply by gross appearance? What would you do if you had 2 specimens, one esophagus and one duodenal and they were reversed in the specimen containers by the biopsy tech? Would you be able to pick up on that mistake? 4. How should you handle a skin punch for alopecia? 5. If sent a skin for frozen, and it was a pilomatrixoma, would you know it, and would you still freeze it, or ask the pathologist first to avoid doing an unnecessary frozen? 6. When are tangential margins more appropriate than perpendicular, and vice versa? You can ask me the same types of questions as they pertain to histology, and there is no chance I can answer them as correctly, and with as much clarity as a well trained HT. The bottom line is patient care and quality. I cannot provide the level of quality in histology as you can, and a grossing tech cannot provide that quality at