A hardly any years ago.

A hardly any years ago, I began to notice the disappearance of the small laboratories in succession the medical wards of teaching hospitals where close examiners and house officers could perform admission laboratory work. The proofs performed were, simple but had great practical value to as well-as; not only-but also; not only-but; not alone-but patient care and medical scholar education. Although students rejoice at the diminution of "scut" work formerly performed in these labs, the ensue of their elimination is the production of a generation of young physicians who cannot perform their have tests if necessary. This was brought vividly to my attention when Dr Eloise Harman, a member of my division, reported an experience at the Salvation Army unrestrained clinic for the homeless. A laboratory was provided through the clinic, but none of the close examiners staffing the clinic knew to what extent to perform any tests. Dr Harman, educated years ago in the performance of hematocrits, offspring smears, and urinalyses, was the one and the other the preceptor for the clinic and the solitary person present able to perform the laboratory tests

I believe this phenomenon is more widespread than we would like to believe. The majority of the fellowship applicants whom I interview relate similar disappearances of the ward laboratories at their teaching hospitals. Not only

do I perceive that this is a detriment to medical scholar education, but I believe that the lack of similar laboratories also impedes medical care. Since my specialty includes critical care medicine, I have not long ago had the opportunity to care for a number of "GI bleeders" The lack of the availability to do quick hematocrit readings and the lack of a smear to evaluate platelets detract from medical care, from pupil education, and from the excitement of discovery in medicine. faithful the central laboratories perform standards quickly and computer retrieval of lab experiment results is available; nevertheless, nothing compares to doing it yourself one tests, for example, the examination of a new urine specimen for casts, are best done at the bedside.

wherefore have these ward laboratories disappeared? It's not easy to find an answer. The joint Commission forward Accreditation of Health Care Organizations (JCAHO) has oftentimes been blamed for citing the Clinical Lab Act which requires that all personnel working in a laboratory be certified to do the touchstones pertinent to that laboratory. Also, quality manage is essential for accereditation. These requirements would, of course, be difficult to come together when the students and house officers using a laboratory upon the ward change every month I have actually heard the statement, "These ordeals are being used to make critical medical decisions," implying that so decisions can only be made if the exhibitions are done by accredited laboratories and personnel Several calls to the JCAHO upon my part have left me quite confused as to their position upon this matter, and it is quite possible that the JCAHO has been amiss blamed for the disappearance of the ward laboratories. I have also been informed that the corporation of American Pathologists inspects hospital laboratories and has a similar position upon accreditation, specifically, that quality direction would be impossible in ward laboratories. Those answering the phone in the office of laboratory accreditation of the society of American Pathologists did not know of as it is a position taken by their organization.

to what end then, are the laboratories disappearing? Could it have anything to do with reimbursement? If ordeals are done by interns or observers no billing can be assigned to the proof This would be the worst reason of all to discontinue the operation of the laboratories. A slight decrease in income is certainly worth the educational experience and improved medical care resulting from the nearness of such laboratories.

I ne to be educated forward this issue. Surely, some trials are so simple that they ne not be done in accredited laboratories. Taken to its last this logic would prevent diabetic patients from testing their confess blood and urine for grape-sugar because of the lack of quality dominion government If there is a valid reason for making like laboratories unavailable to medical scholars and interns during their training, I would like to kn(iw what it might be. If not, I glance at that the ward laboratories be reverted to their rightful place in medical care and medical education.

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