Who does IHC?
First to answer your survey...
1) We have 7 techs (counting myself) 5 of us do IHC. The 2 that don't are
from a smaller hospital we have just integrated. I have only been
responsible for them since April 1 and they may start IHC sometime down the
2) Can't speak for the state of New York, but Wisconsin and Minnesota
certainly do not require IHC performance by an HTL. If it is true in New
York (or anywhere for that matter) you certainly would limit the testing
done and be wasting a lot of talent in histology (hard enough to come by
these days anyway).
Secondly your situation...
I don't know what your lab set-up is techs, paths, scope of service, etc.
and how much your lab manager understands about histology (specifically IHC)
but I will share our approach. Even though 5 of us do IHC (Dako Autostainer,
approximately 75 antibodies) one person is our technical specialist for IHC.
The tech specialist is responsible for the major maintenance of our IHC
service. He keeps the QC records, troubleshoots, and develops and expands
the service. He also serves as a referral for the pathologists and keeps the
staff updated on a weekly basis at our lab meeting. We also have one person
designated behind him to cover vacation, holiday and sick days. This works
well since it takes some pressure off the other techs and allows for clear
communication and direction.
The workload in this lab is divided up for the most part in the same
fashion. Each staff person is responsible for an area and/or function of our
service (safety and supplies, reagent recycling, and special staining-non
IHC). These responsibilities are in addition to what we designate as
standard work in here (accessioning, minor-gross dictation, embedding,
sectioning, H+E staining etc.). I mention these things because you said your
lab manager wants everybody to do everything and you for the most part
agree. I understand this philosophy and share it, however I believe a
certain amount of specialization and separate responsibility are necessary
in this day and age. Everyone in here can do everything for the most part,
but we can default to each other if necessary.
The reason I mention your lab manager and her depth of understanding of
histology is because I think she would be looking to you for expertise in
histology (unless she has some) and allow you the freedom to re-assess your
current operation. Obviously, you cannot have a lot of rework and
unhappy/mistrusting pathologists. Not everyone is cut out to do IHC or at
least have a level of responsibility that perhaps your situation currently
demands. That's the way a lot of things in life are. I'm not saying our way
of doing things is perfect, far from it and everyone's a little different.
I've just tried to identify the talent in here and apply it the best I can.
Sorry to ramble on, but I truly hope this helps. If you have any questions
feel free to contact me anytime. Good luck!
Thomas Jasper HT(ASCP) BAS
Histology Team Leader
SMDC Clinical Laboratory
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