Bringing It All Together

Do you choose to be a specialist or generalist in your career? The Harvard Business Review points out that, while we have become a society of specialists, that era may be waning as generalists are increasingly considered more adaptable.1 Generalists are able to learn from a broad experience to hone critical thinking skills, too. As a generalist, you can gain an all-important clinical perspective that brings it all together for the patient.

Specialist vs. Generalist
It isn’t uncommon in large laboratories for technologists to specialize in departments. Technologists may work exclusively in hematology, chemistry, microbiology or other areas. Forbes staff writer Meghan Casserly draws an analogy to the animal kingdom, in which a koala bear is a specialist that can only survive in specific conditions, whereas generalists like mice can thrive in almost any environment. Competition breeds specialization, but when an ecosystem changes, she reminds us, generalists come out on top.2

There’s no right or wrong career decision here. It can be gratifying to work in a particular department or sub-specialty and become an expert in that area. Your expertise can add value to your professional relationships and enhance your career chances. But the same can be said of a generalist who sees the “big picture” and adapts multiple skills in multiple departments.

According to one source, business trends may be shifting from specialists to generalists as employers want to do more with less. As a laboratory manager, you may want generalists to fill multiple roles, for example, because that’s the biggest bang for the buck. For those starting a career in laboratory medicine, being a generalist makes good sense because it lets you test different areas before specializing. And generalist skills are useful later in a career, too, as management opportunities that demand a broader view become available.3

The big picture – bringing it all together – can be uniquely gratifying for the generalist on the bench. An evening technologist, for example, may process multiple specimens on the same patient, consult with an ED physician and gain a valuable perspective on the condition, diagnosis and treatment of a patient.

Case Studies
Consider these two case studies:

– A 35-year-old man is admitted to the ED with severe right flank pain and a recent history of vomiting, but no chills or fever. Specimens arrive in the laboratory for urinalysis, complete blood count (CBC) and basic metabolic panel (BMP). Pertinent lab results are listed in the Table.

– A 50-year-old woman is admitted to the ED with a history of intermittent, dull flank pain and general fatigue. She reports a more constant flank pain recently and low-grade fever. Her temperature is 39.2 øC. Specimens arrive for urinalysis, CBC and BMP. Lab results are listed in the Table. The ED physician also orders urine and blood cultures.

What a bench tech won’t normally know is what the imaging studies show. An abdominal x-ray of the 35-year-old shows a 5-mm calcification presumed to be a kidney stone in the right ureter. A right renal ultrasound shows a mild hydronephrosis, or swelling of the kidney. A KUB (Kidney, Ureter and Bladder x-ray) of the 50-year-old shows a staghorn stone of the left kidney in the renal calyces (the chambers in the kidney passing urine). Subsequently, her urine culture is positive for Pseudomonas aeruginosa. Her blood culture is negative.

Nephrolithiasis, or kidney stones (Gr. nephros- kidney + lithos stone), have a prevalence of 1 in 1000 U.S. adults, but are nearly three times more common in men. 17 percent of the population will have kidney stones at some time, most likely over the age of 30, during a lifetime. Further, the incidence of kidney stones has increased 5 percent between the 1970s and 1990s.

Kidney stones are hard masses accreted from crystals in the urinary tract. Tiny crystals and calculi will pass undetected through the ureters and bladder and be asymptomatic, whereas larger stones can cause episodes of severe flank pain radiating to the abdomen and/or groin (called renal colic) and obstruct the ureter, causing hydronephrosis as urine backs up. Other signs and symptoms may include: pain with urination; pink, red or brown urine; nausea and vomiting; persistent urge to urinate; fever and chills; and foul-smelling urine.

Life-style, family history and disease all play a role in kidney stone formation. Foods that are high in oxalates, such as nuts, beets, spinach, etc., may cause people to be more likely to form calcium oxalate stones, the most common type. A positive family history makes it 30 percent more likely to develop kidney stones. And urinary tract infections, cystic kidney disease and certain metabolic disorders increase the likelihood.

Calcium stones, with or without hypercalciuria as measured in a twenty-four hour collection, are found in 70 percent of patients with kidney stones and are associated with calcium oxalate crystals in urine. Stone analysis is required to identify the type of stone. A “staghorn” stone is often composed of magnesium ammonium phosphate and/or calcium carbonate apatite and is strongly associated with urinary tract infection from urease-producing bacteria, such as Proteus, Pseudomonas, Klebsiella, etc. Staghorn stones are just what they sound like: large, branched stones that inhabit some (partial) or all (complete) of the calices.4,5,6

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