Demystifying the world of phlebotomists

These healthcare workers don't want to suck your blood ? they just want a little respect

By Peter Woodford

The word phlebotomist is derived from the Greek term for bloodletting. Some still judge the trade by its sanguinary roots. A compendium of doctor slang (see "Is medical slang GPO?" ) has not one but two disparaging nicknames for phlebotomists, namely bloodsuckers and vampires.

Though phlebotomists aren't exactly raking in the praise, their higher-ups certainly aren't stingy with the finger-pointing when things go wrong. Should a phlebotomist do a poor job, it's pretty easy for a doctor or nurse to notice. The most common occupational errors are struck nerves, jabbed arteries or a fainting blood-deprived patient left to tumble to the unforgiving hospital floor.

TAINTED BLOODLETTERS
The fact Canadians hear so little about the nation's phlebotomists can be seen, at least partly, as a good thing. It means we haven't had any large-scale blood-draw disasters like the case in Palo Alto, California in 1999 where a phlebotomist was found to be washing and reusing needles over a span of four years. Over 3,000 patients needed to be tested for HIV after the debacle and California was forced to enact a complete overhaul of phlebotomist qualifications. Phlebotomists there must now have at least 80 hours of practical training and certification.

Louisiana adopted a similar code soon thereafter, but for the rest of the US, phlebotomy standards remain fairly haphazard. An opinion piece by Dr Ranit Mishori appeared recently in the Washington Post criticizing the relative lack of regulations governing the field. She writes that a phlebotomist may be "dressed in medical scrubs. That doesn't mean he's been to medical school or nursing school... or any school at all."

FINE ART OF PHLEBOTOMY
Joshua M Hinton, who works as a phlebotomist at Southwest Medical Center in Liberal, Kansas, is likewise concerned with the state of his trade. "Inadequate training is a plague to the phlebotomy system in America," he says. "Quite a number of places, especially in rural regions, use on-the-job training. This requires no previous medical experience and the amount of training time varies." Mr Hinton adds: "Personally, I prefer at least two months training, but I've seen some on-the-job training sessions last less than one day. It's impossible to learn the fine art and detailed science that's involved with phlebotomy in that short time."

Mr Hinton shares Dr Mishori's concerns about adverse events that he feels are a result of phlebotomists' desultory training. "This lack of training and knowledge often leads to erroneous test results," says Mr Hinton. "Such inaccuracies can result in a misdiagnosis, incorrect treatments, and even death."

PHLEBOTOMY NORTH
Canada's phlebotomists are generally required to train between six and 14 months before working in a medical laboratory. Quebec is a particularly demanding jurisdiction; phlebotomists there must go through three years of post-secondary school before they hit the veins. Phlebotomist data is scant, but one Government of Canada source at least details phlebotomists' pay range: $14 to $18 per hour.

Angela Taddio is a phlebotomist at Montreal's Jewish General Hospital. She hints that her province's three-year program might be overkill. "One problem with the job of a phlebotomist/medical lab technician is monotony," she says. "I'm very much in favour of rotational schemes where job duties are shifted. It can be extremely monotonous just doing blood draws. The education we receive allows us to do much more."

A LITTLE RESPECT
The reality is that even well-trained phlebotomists have a hard time getting respect from their fellow caregivers. Both Ms Taddio and Mr Hinton find the physician/phlebotomist relationship uneasy at times. "Several of the doctors work well with us, and will even take the time to have a casual conversation," says Mr Hinton. "Still, we have some specialists who feel phlebotomists are undereducated people not worthy of their time."

Ms Taddio hasn't had too much trouble with docs, but can't say the same for nurses. "At my current post we don't really work with doctors very closely at all, but formerly at the Montreal Children's Hospital I had good working relationships with the doctors," she says. "That said, when doing rounds there is a noticeable friction between technologists and nurses. And we're all very aware of the 'vampire' tag doctors give us and I find it irritating."

Mr Hinton takes phlebotomist-directed insolence in stride. "I've been referred to as a vampire on multiple occasions, mostly by patients. I try not to be offended," he says sanguinely. "I realize that it is a half-hearted attempt at humour. Humour often helps the patient relax and handle the phlebotomy process better."