Technical progress in the doctor's office

An Interview with Priska Burri

How long have you been a medical assistant?

I started my training as a certified medical assistant in 1994 and in the summer of 1995 I started working in my first medical practice. At that time, the profession was not yet recognized by the state, so I attended a private school where I received theoretical instruction in the first year and then completed the practical part as an internship in a doctor's office. In 1996 the first medical assistant (MPA) started their training. Since then, this has been a three-year apprenticeship.

Which analyses were done with other techniques in the past?

In my apprenticeship, the quick was still "humped". In the doctor's office, however, we already had a device in which you could walk away during the analysis. This was a rotating tube in which a bead was attached to a string. As soon as the blood began to clot, the bead was pulled away and a light barrier was triggered, which then stopped the time.

Cell counting for leukocytes and platelets was also quite different in the past. This was done manually by placing the blood in counting chambers with reagents and counting all the cells in the grid under the microscope. This easily took 30 minutes per blood. And with the Lange cell test, we did wet chemistry-clinical chemistry analyses. The first analyzers, such as the Reflotron, were already available at that time, but I did not have them in my practice. A lot was also sent to the external laboratory, e.g. the CRP because the methods at that time were too inaccurate. Later we measured CRP and HbA1c with the Nycocard Reader.

There were also a few quick tests, e.g. the pregnancy test.

The time required at that time was enormous compared to today. For many analyses, the reagents had to be dissolved first and the instruments had to be adjusted to the respective analysis with special factors. So we collected all the samples and started processing them in the laboratory from 4:00 p.m. onwards. And not patient by patient, but sorted by analysis. First all bilirubins, etc.

How were internal and external quality controls done at that time?

The external interlaboratory test already existed and we participated in it 4 times a year. However, internal quality controls were not yet the rule at that time. In some cases, duplicate determinations were made, but this was also another time and cost issue. In the case of the Quick and cell counting, we always made duplicate determinations.

How has technical progress changed your everyday work?

It has changed a lot. Thanks to electronic medical records, you can finally read the doctor's notes (she laughs). I'm sure that's also mutual. This also makes it easier to provide information when patients have queries. The documents are now also sorted chronologically. In the past, you sometimes had 10-cm-thick medical history books and had to search for documents.

Laboratory-wise, I now have much more time for many more analyses. In the past, I would never have been able to do as much lab work in one day as I do today. It simply would not have been possible. The fact that the devices now automatically transfer the results to the electronic KG is also a huge relief and minimizes the source of errors - as long as you have entered the patient ID correctly.

In the past, we still wrote reports with a typewriter. If there were a lot of typing errors, you had to rewrite the report. The computer has made the work much easier. With the electronic KG, it's even easier, because you can take over the text directly and have to add a sentence if necessary. And then the report is no longer sent by mail, but via a protected e-mail address.

Digital X-ray has also changed the entire process. There is no longer any need for a darkroom or reagent baths, which had to be changed every three months. And the X-rays can be sent along on a CD. We even had a hair dryer in the office so I could dry dry urgent x-rays.

Are there also negative sides to progress?

Progress has changed a lot in our profession. Despite everything, administrative work has increased a lot. Health insurance companies are asking questions, patients are writing e-mails, etc. The demands of the patients themselves have also increased greatly.

In the practice lab today, it's just operating machines. If you enjoyed pipetting and measuring back then, you miss it a bit today. But I also see that there is no other way today.