Chapter 10: MLTs Working for Others and the Self-employed Technologist

In virtually all practice settings, MLTs in Nova Scotia work for someone else; however, there are opportunities for self employment as the owner of a blood collection service or private lab. Whether you work for yourself as an MLT or for someone else, remember that you are subject to the applicable legislation and regulations. If you work for, or with, larger institutions (such as medical labs that accept specimens), you will also be governed by their protocols and accreditation requirements.

Working for Others

When you work for someone else, your employer will normally take responsibility for meeting the requirements of business, and comply with any legislation or regulations that govern that business. Your job description will prescribe whether any of these things are your responsibility and employer protocol will guide you in dealing with them. Thus, the weight of many decisions and requirements will not rest with you.

Being an employee can have its challenges however. Employers share the views and objectives of the NSCMLT with respect to the Code of Professional Conduct and the profession’s standards of practice—they want and expect MLTs to exhibit the professionalism characteristic of our profession. But there is the possibility that your employer may ask you to do something that you feel is unethical or otherwise unprofessional.

An important point to keep in mind is that you are ultimately responsible for your own actions as an MLT: the Code of Professional Conduct states that “medical laboratory professionals shall take responsibility for their professional acts.” Common sense should also guide you to always uphold the standards of the profession: a defense of “my boss told me to do it” will not stand up either in an investigation by the College or in a court of law.

SCENARIO:

Finn, a cytotechnologist, arrives for work one morning and learns that the microscope at his workstation has been taken for servicing and repair. His supervisor has arranged to borrow a microscope from another department temporarily, so that Finn can work as usual.

The borrowed microscope appears quite old, and Finn hopes that the optics will be good enough to reveal fine microscopic detail in the slides he’ll be reading. He sits down and puts a quality control slide on the microscope stage. As he fears, the resolution is not good and abnormal features in cells on the slide are not clearly visible to him.

Finn takes the time to thoroughly clean the lenses of the microscope and center the lighting so he can get the best possible performance from the microscope. He also tries several more quality control slides to make sure it’s the microscope that’s the problem. Nothing helps. Finally, he informs his supervisor that he can’t use the microscope.

The supervisor puts a slide on the microscope stage and has a look. After several minutes, she says that she thinks the microscope will do if Finn takes his time, and suggests that he can confirm positives on one of the other microscopes in the lab. She promises to call and ask that the original microscope be returned as soon as possible.

Finn attempts to do as his supervisor suggests, but the resolution is just not good enough. He is painfully aware that confirming positives on another microscope provides no insurance against missing a positive. Continuing to read patient slides under these circumstances goes against his personal ethics and the CSMLS Code of Professional Conduct. He politely but firmly informs his supervisor that he won’t continue to use the microscope.

In a disagreement between an employee and an employer (or an educator and student), there is an inherent imbalance of power, and it’s not in the employee/student’s favor. However, it need not deteriorate into an unpleasant or destructive battle of wills; professionalism and good communication will often resolve an issue to everyone’s satisfaction. If you find yourself in an awkward situation, the strategy for resolving conflict described in Chapter 9 can help. Above all, remain calm and professional, and consider the following additional actions:

• Make sure you are right. Check the relevant documents if necessary— legislation, standards, accreditation requirements, employer policies, published literature etc.—to be sure that what you’ve been asked to do is, in fact, inappropriate.
• Ask for clarification to be sure you understand exactly what you’re being asked to do, and why. Carefully explain your reservations.
• Discuss the situation with another MLT or other health professional to get a different point of view. Does the other person offer an alternate interpretation of the situation?
• If an alternate approach to the problem occurs to you, suggest it.
• Document the details of the disagreement.
• If you can’t reach an agreement that you’re comfortable with, politely but firmly refuse to compromise your professionalism.

A final suggestion might realistically read “Hope that you don’t endure negative consequences as a result of your refusal.” While reprisal and even disciplinary action are possible, your refusal might also cause your opponent to reassess his/her position on the matter. In a worst-case scenario, you can ask other bodies such as the College, your labor union, or the NS legal system for help. All positive outcomes depend on your professionalism, and your attention to the first point of advice above: “Make sure you are right.”

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Working for Yourself

Being self-employed or starting up a small business can be an exciting opportunity with many rewards. It comes with considerable responsibility, however, and the self-employed MLT in Nova Scotia must keep the following in mind:

• If you use the MLT designation, you must be licensed with the NSCMLT, and you must be doing work that falls within the NSCMLT scope of practice.
• If you deal with the public, be transparent: clearly identify yourself, preferably in your business name.
• You are subject to all the legislation and regulation that governs MLTs in Nova Scotia, including requirements for consent, and for keeping personal health information records confidential and accessible to clients.
• You must abide by the terms of any contract signed with hospitals or other institutions, and follow employer protocols where this is relevant.
• Some work that falls within the MLT scope of practice, such as blood collection, can be performed by others; however, if the work does not fall within the other person’s professional scope of practice under another act, then
• they must be assisting an MLT and their work must be overseen by an MLT. This means that if you employ others who are not MLTs, the professional responsibility for their work rests with you.

Patient/client and employee records are an important responsibility. It is a challenge for the small business owner to care for these records properly and dispose of them in a timely fashion. Recall from chapter five that anyone who holds the personal health information of others must have a schedule for disposal of the records – normally 10 years after the record was made, or ten years after the patient reaches the age of 19 years. In contrast, employers must keep employee records for at least three years, and Revenue Canada requires that business records be kept for at least six years. Be sure you understand when records can and should be disposed of, and how to safely dispose of them.

Another important area of concern is billing. You will likely be billing clients for your services and you need to adhere not only to good business practices but also to medical ethics. Take care not to disadvantage or exploit vulnerable clients.

SCENARIO:

You are the sole proprietor of a private blood collection company. You take the calls, make the appointments, set the fees and take the blood. One of your clients is a war veteran who still lives at home but has mobility challenges that make it difficult for him to get to a clinic for blood collection. One day, he suggests that you could be charging more for your services, especially for people who are covered for this expense by medical insurance plans. He informs you that he has such coverage and will be reimbursed for whatever he pays you. He won’t tell, he says with a wink, if you don’t.

In the end, your client hands you $40 for a visit that would normally cost $30, and you write him a receipt for $50, so both of you make a bit extra.

This is insurance fraud on a small scale. Though it does not directly harm the client, assuming he knows the conditions of his medical insurance, it’s illegal and unethical. The indirect costs associated with this type of thing are well known, and accrue to us all. In other situations, billing certain patients differently based on their ability to pay could do more direct harm.

The following are unethical billing practices:

• asking more from a client who appears wealthy
• charging someone more because they are not in a position to refuse your demand
• charging more because you know that the client will be reimbursed
• offering a discount for immediate payment (this potentially disadvantages those with limited funds)

Finally, in deciding how to set up your own business, be sure you understand the differences between sole proprietorships, limited companies, and corporations, and familiarize yourself with Revenue Canada’s rules for these businesses. There is good information at the Access Nova Scotia website (Registry of Joint Stock Companies). Good luck with your company!

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Conclusion

Whether you are self employed or employed by someone else, you’ll have to deal with professional challenges and ethical dilemmas from time to time. A thorough knowledge of employer policies, and the legislation and regulations that apply to your situation will provide clear direction in most instances. When employer or client demands conflict with professional ethics, do your best to reach a consensus, and refer to the CSMLS Code of Professional Conduct.

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