Healing behind closed doors

Biomedical scientists have no wish to become doctors, says David Ricketts, a chartered scientist and manager of a team of 35 at the department of clinical chemistry at the North Middlesex University Hospital NHS Trust, but their unique understanding of human tissue and body fluids "undoubtedly provides doctors with the vital scientific information that allows them to do their job properly".

To Ricketts, 41, a fellow of the Institute of Biomedical Science who represents the Institute on a wide range of professional and governmental committees and who regularly speaks here and abroad about developments in this 17,000-strong profession, the worst thing a biomedical scientist can be called is a "lab technician".

"Although some people still use that term, it is pretty hackneyed. In truth, we are a graduate-only profession at the cutting edge of science and medicine. Far from being shut up in labs all day, we regularly go on ward rounds with doctors and get to know our patients. It's true that the profession used to adopt a `fortress pathology' approach, but nowadays we are very keen to work alongside other medical professionals."

In basic terms, biomedical scientists use their sample analysis, chemistry- based skills to identify what is going on in a patient's body and help pinpoint and monitor the correct treatment. With new diseases such as HIV and human variant CJD jostling for position alongside the returnees such as TB, it is little wonder that around 70 per cent of the average patient's notes are pathology-based.

Although some biomedical scientists do opt for full medical training, Ricketts says he had no real vocation to become a doctor and even if he had, he says he would have been deterred by the necessity to get straight A grades at A-level.

"At 18 or so, with chemistry and zoology A-levels under my belt, I knew I wanted a job in science, but I wasn't sure which branch would suit me. When I saw an advert for a junior lab assistant at my local hospital - Oldchurch Hospital, Romford - like many people, I assumed it would be about pushing dead bodies around. Once I discovered it was about using analysers and chemicals and looking at samples drawn from living patients, I was a lot more enthusiastic."

Back then - and it's no different today - the registration criteria for biomedical scientists was stringent. For Ricketts, qualification was via the HNC route; it took three years in all and culminated in a very difficult oral exam. For today's graduate entrant, registration typically takes 18 months to achieve, but the oral exam - designed to prevent misdiagnosis later on in a biomedical scientist's career - remains equally tough.

Biomedical science is not an ideal career choice for the squeamish - blood, urine and other human samples are all in a day's work. And Ricketts stresses that without stringent safety procedures, it would be a dangerous one.

"We deal with some really nasty diseases and some very sick people; wearing gloves when we handle samples is only one aspect of our safety procedure," he says.

Although the job may entail exposure to some pretty nasty looking and smelling samples, he believes that the only people who regularly faint in a lab are teachers who bring in children to see the work of biomedical scientists. "It isn't that we have particularly strong stomachs," he says, "but I suppose we in the profession tend to be pretty immune to how a sample looks or smells."

Ricketts says the discovery of HIV marked "a sea change in biomedical science and a real challenge to our safe practices". Although the discovery of this blood-borne disease has been an immense challenge to the profession, giving rise to new safety standards which may, in the early days, have gone "well beyond what was actually necessary", current safety procedures are, he believes, about right. "If you follow the rules, he says, "you would have to be pretty stupid to catch HIV from a lab sample."

Today, Ricketts is on the Institute team that is involved in setting National Occupational Standards for bio-medical science, as part of the Government's modernisation plans for the whole healthcare profession. "Standards for all biomedical scientists are very dear to my heart and I am proud to be taking a role in writing such standards alongside colleagues," he says. Among his long list of professional and management roles, Ricketts also serves on the National Pathology Modernisation committee as a representative of his profession.

As a manager of 35 staff, Ricketts is well aware of the danger of losing touch with the coal-face of biomedical science. To keep in touch with the attitudes of his team, he regularly covers the out-of-hours service at North Middlesex - where the lab is open 24 hours a day, 365 days a year - and once a month does the night duty. He encourages his staff to strike up a personal rapport with doctors and nursing staff, rather than relying on the telephone, and to meet patients.

"In the old `lab technician' days, it may have been harder to relate tests and results to human beings, but today, all of us are acutely aware of the human implications of what we may discover in a sample."

Automation is a key feature of today's chemical pathology work and without it, says Ricketts, "we'd need tens of thousands of test tubes a day in this department alone". Automation, he says, is to be welcomed, not despised. "Analysers can quickly produce results relating to liver function, kidneys and thyroids, they can pinpoint diabetes, drug abuse and overdoses and they can also monitor certain cancers. This doesn't mean that they are putting us out of a job though."

"Automation puts us in the driving seat when it comes to monitoring and improving quality control and it also frees up the time that would once have been spent on routine blood-testing, say, to take up advisory roles in transfusion or anticoagulant clinics perhaps."

He adds: "Although the downside of my job is the knowledge that we could do so much more if the resources were there, the upside is that I have never come to work wondering what I do it for, or worrying that my job doesn't make a difference to people's lives. It's a very satisfying and worthwhile job and while no one comes into the health service hoping to become a millionaire, the money is far better than it used to be."

Now half-way through a doctorate in biomedical science with Portsmouth University, Ricketts applauds the new mood of openness in the profession. "Fortress pathology is no more," he says, "the walls are well and truly down."