Do Histotechnologists Lack Respect?

In response to my note of July 29, 2006, entitled My Not-So-Secret Life as a Blogger (link here), Rene Buesca submitted the following comment that I believe is worthy of additional discussion:

I really hope that this weblog will contain more comments about histology. Have you notice that histology, from the written material point of view, is the backwater area in the Medical Lab? Why? Because of the educational background of the early histotechs (HT)? Because the HT just dedicate themselves to their manual work? Because of lack of encouragement from pathologists and laboratory managers and supervisors? So far I have been unable to fathom why, but this would really be a very interesting "blogging" topic.

Let's assume that Rene's premise is correct -- that histotechnologists (HTs) do not command sufficient respect given their great contributions to pathology. He refers to the histology lab as a backwater to explain this lack of respect. Here are some reasons that may help to explain their perceived (or actual) lack of status. I would be interested in hearing from any of the readers of this blog who want to weigh in on this topic:

• HTs are highly skilled individuals working in a specialized lab area that is hidden from most hospital personnel and patients. This may result in an "out of sight and out of mind" attitude toward them. However, the same complaint is often voiced by all lab professionals.
• In my opinion, anatomic pathology frequently lacks forceful middle level managers with political traction equivalent to that of the chief technologists in the various clinical labs. Because of this, political and organizational advocacy for histotechnologists may be lacking.
• The major CP labs like chemistry, molecular diagnostics, and hematology gain political and financial momentum by the introduction of new tests that often require new equipment. When capital funds are being allocated, the histology lab often gets less attention than it deserves.
• I am interested to Rene's reference to HTs performing manual work. I personally reserve this term to refer to unskilled labor rather than to the skilled work of technologists. However, he may be on to something regarding the lack of complex equipment in the histology lab that may result in lower prestige for those in the field.

Comments

[janice Mahoney]

I want to add a few comments regarding the topic of Histotechnology. I have been a Histology Tech for over 30 years and have been in management for about half of that time. I LOVE being a Histo tech. It is the perfect marriage of science and art. In the past 10 years or so the field has become more of both. The demand on Histo techs to become perfectionists when embedding and cutting tissue has increased. We have smaller and smaller samples of tissue to work with as less invasive surgical procedures become the norm. The demand for expertice to perform and troubleshoot immunohistochemistry and molecular techniques is also on the rise.
All Anatomic Pathology managers are challenged to find the right combination of skill and knowledge in potential employees.
Why has Histology been in the basement/backwater for so long? It is a bit of a mystery to me but I believe it to be true. It may be that until recently Histology has usually been managed by Med techs who either do not understand Anatomic Pathology or by those those who "learned to do histo" when they went to med tech school many years ago.
Well, things have changed dramatically. We can no longer hack off a chunk of tissue, slap it on a slide and say "good enough". There is, more often than not, no second change to get it right. Often we are challenged to cut routine H&E slides and an additional 40 or more slides for IHC on a piece of tissue no larger than a thread. That requires great skill and patience.
Every person who has a biopsy, knows someone having a biopsy or cares about finding a cure for cancer(for those histo techs working in research) should thank a histo tech today. They are dedicated scientists and artists who are too often undervalued yet make valuable contributions daily to patient care.

[René J. Buesa]

Two things: I define manual work to that work done manually, without the intervention of automated instruments. Histology is the least automated area of the medical laboratory and only basic tasks or steps, like tissue processing, staining and coverslipping have been automated. The rest that include the essential tasks (embedding and sectioning) are done manually. In no way being "manual" is detrimental, Rembrandt would agree with me.
The second aspect is that "the art of histology" (because it is an art) is seldom appreciated. In 2003 I was asked to write the Feature article for vol.26No2 of the Journal of Histotechnology and I titled it: Histochemistry: a case of unappreciated beauty? My former boss sent a letter to the Editor stating that pathologists appreciate our art. I answered in another letter and concluded saying:"Not knowing that our work is appreciated, when according with Dr.A. it is, makes our histochemistry work less a case of unappreciated beauty and more a case of platonic love!
Usually our contacts with the pathologists are to received orders or complaints.

[Kenneth Youens]

Dr. Friedman,
I agree with your comments regarding the importance of histotechnology. I was struck by a phrase that that Rene Buesca used: "lack of encouragement from pathologists and laboratory managers and supervisors". I think this idea is partially true. Histotechnologists, aside from those doing frozen sections, are rarely seen in person by the pathologists, at least at my institution. Usually, interactions are in the form of phone calls, most of which are either orders or reports of problems. I wonder how often HTs are reminded that they are making a vital contribution to health care. Compare their situation to the front-lines job of, say, a radiology technologist, and consider how little positive feedback our histologists must get.