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Student health lab: a different MT experience.

Student health lab: A different MT experience

When I go to work, I also go to school. I have the unique opportunity to work at both a clinical lab and its collegiate satelite at Stanford University.

The Palo Alto Medical Foundation (PAMF), a clinic staffed by 175 physicians, has operated this satellite since 1945 - more than 20 years before the university built its own hospital. When I joined PAMF 15 years ago, my fellow technologists and I took turns on a monthly rotation at the health center lab to assist the technologist assigned there full time. Six years ago, Standford decided to halt these rotations and reduce the position to permanent part-time status to cut personnel costs. I decided to apply for the transfer.

As a new mother, I had already cut back my work schedule. It has worked out splendidly. I now work from 9 a.m. until 1:30 p.m. whenever the university is in session. All summer long and during quarter breaks, when very few students are around, I return to the much larger clinic - a couple of miles away - to help out in the hematology laboratory. * What's unique. The differences between a student health center laboratory and a clinic or hospital lab go far beyond size, types of instruments used, and numbers of technologiests employed. The student clientele and the "phases" of their health throughout the school year dictate the test meny, test volume, and work pace. Interaction with other health care providers - a rare commodity in more conventional labs - is frequent, greatly benefiting our patients.

The Cowell Student Health Center is operated exclusively for the use of Stanford University students and their families. Six physicians, three nurse practitioners, and a full-time and a half-time technologist provide basic health care for 6,000 undergraduates, 6,500 graduate students, and their spouses and children. (Specialists in dermatology, orthopedics, and gynecology and a resident from the Stanford University School of Medicine also have scheduled rotations.) The two-story health center houses examining rooms and offices for each doctor, a treatment room for immediate care, a laboratory, an x-ray room, a physical therapy department, and an infirmary. * Daily routine. Each student who comes to the health center fills out a questionnaire. A triage nurse then sends him or her to a treatment room or schedules an appointment with a physician or nurse practitioner. If laboratory work is indicated, the patient and the appropriate forms end up in our lab, which consists of a single room. Counters serve as "departments" of hematology, urinalysis, bacteriology, and serology. The 1.5 technologists share all the work, with no room for specialization. The hematology supervisor at PAMF monitors the lab's day-to-day operation. A clinic-based physician serves as medical director.

Although PAMF hires and pays the employees at the health center, the university owns all our major equipment. Because funds are scarce, we use an early-model cell counter instead of sophisticated instruments and computers. All results are recorded manually. Performing a CBC requires doing a microhematocrit, a dilution for a WBC on a Coulter D[.sub.2], and a hemoglobin on a hemoglobinometer. Naturally, we'd like to upgrade, but this system has worked well for many years. * How students help. Stanford students help ease our workload, filling in as phlebotomists and lab aides. They greet patients, draw blood, process paperwork, receive and distribute specimens, file reports, and restock supplies. These part-timers work a maximum of 10 hours per week, depending on their class schedules. Since schoolwork is expected to come first, the technologists must pick up any slack, especially during the summer break. At that point the full-time technologist works alone and remains until 5:30 p.m. If necessary, I delay my usual 1:30 p.m. departure.

The main reason our laboratory operates differently from more traditional ones is our clientele. Hospitals and larger clinics typically treat a wide range of health problems among patients of all ages, from the newborn to the geriatric. A student health center, on the other hand, predominantly sees young adults who are in relatively good physical condition. We rarely encounter any serious cases; when we do, we usually refer them to PAMF or Stanford Hospital right away.

Our patient population has its own health problems, as reflected in our test menu. Colds, flu, mononucleosis, sore throats, and urinary tract infections are common among college students. Not surprisingly, the bulk of our workload consists of CBCs, urinalyses, and strep screens. * STDs. As on any other campus, there is much concern about sexually transmitted diseases. We streak bi-plates for gonococci and perform a two-glass (split urinalysis) on specimens from male patients to help doctors distinguish between involvement in the urethra, suggesting gonococcal involvement, and in the bladder. To provide more comprehensive care for our female patients, we perform urine pregnancy tests, wet mounts for Trichomonas and fungi, and urine screening cultures. We considered offering in-house testing for Chlamydia, but decided it was more economical to send such specimens to the laboratory at the clinic.

The in-house test menu also includes erythrocyte sedimentation rates, eosinophil counts, KOH wet mounts, Gram stains, occult blood cards, and wet or dry smears for leukocytes. Other types of cultures, all blood chemistry studies, and more complicated tests are performed at PAMF or, occasionally, at a reference lab. We send 10 to 20 HIV antibody tests to PAMF each month. The lab there performs an ELISA and refers any positives for the follow-up Western Blot. * The usual infections. Each academic quarter brings a predictable cycle of maladies. Healthy and rested students quickly subject themselves to all-night studying and partying sessions, with the attendant viruses, strep throats, and urinary tract infections. Exams lead to less sleep, more stress - and mononucleosis. At the end of each term we invariably receive a rush of requests for pregnancy tests and for STDs. The winter quarter yields the heaviest test volume, possibly because the increased indoor contact encourages pathogens to thrive in a warm, moist climate.

I realize, of course, that to a worker at a hospital lab that runs hundreds of complete blood counts and urine assays a day, our 10 CBCs or dozen UAs might seem laughable. Yet because there are only two of us, we often feel more harried than technologists in big labs. While a technologist in a traditional laboratory tends to spend most of the day at the same workstation, we usually find ourselves juggling tests at several stations plus drawing blood.

Although we're small, our workload is not. The health center logs more than 45,000 patient visits per year. The pediatrician deals with another 2,000. At the lab, we perform about 15,000 tests annually and process another 7,000 send-outs, referring most of the latter to PAMF. This past winter was particularly hectic. In January 1989, we did 1,432 tests in-house. The monthly volume climbed by about 100 tests in February and returned to roughly 1,400 tests in March.

I like working in this little lab so much that I always undergo a mild case of culture shock when the university closes and I transfer back to the clinic. I miss the lab's fast-paced routine and the diversity of the workload. I also miss the day-to-day interaction with the health center's medical staff. I'm glad I took advantage of this unique opportunity.
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Title Annotation:medical technologist
Author:Jonas, Melanie K.
Publication:Medical Laboratory Observer
Date:Jan 1, 1990
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