From microbiology to clinical microbiology


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From microbiology to clinical microbiology

  1. 1. FROM MICROBIOLOGY TO CLINICAL MICROBIOLOGY CAN WE MAKE IT? Dr.T.V.Rao MDThe Curriculum in Microbiology in the Indian contest remained static forseveral decades, the training in MD (Microbiology) under Medical Facultyremained without clinical approaches in Diagnosis and treatment. Muchof Medical Microbiology remained to the Laboratory with little interest inthe Hospital practice. Every Medically qualified MicrobiologistspendsMajoryears of life in a speciality without much productivity and newerinnovations. Thanks to several curricular changes in efforts to makesubject, as par with a Clinical Speciality. Fewer allocations from bothGovernment and Private Institutionsin funding and shortage ofqualifiedtechnicians have brought the speciality to brink ofdeterioration.The Pandemic of AIDS awakened the Society and Doctors,that spread of AIDS cannot be controlled with Laboratories, but ourcontinuous understanding of the Society, and greater understandingofthe disease with clinical knowledge. I think it is time that we shouldbecome active to make Microbiology as Clinical Microbiology with ourunited efforts. At present we all study in-depth M i c r o b i o l o g i c a laspects dealing particularly with theoretical and little practicalknowledge of medical diagnostics. It also focuses on molecular andconventional techniques for isolating, identifying and characterizingbacterial, viral, fungal and parasitic pathogens, as well as preventionand control of infectious diseases, epidemiology, and details ofspecimen collection, handling, examination and interpretation ofresults. However a little interactions with our knowledge of Medicinemake greater contributions. At present curriculum is elaborate andwide without much specificities, creates greater confusion. My littleexperience as qualified in MD from reputed Government Institutionmake me to realize that I do not practice even 10% of the knowledgegained in my post graduation, and Post graduate degrees make you aundergraduate teachers at the most a postgraduate examiner afteryears of our service. It is questionable how much we are productive tothe society. The reasons are many clinicians go on their own waythinking antibiotics can solve all problems, which has lead to growingconcerns on Antibiotic multidrug, pan drug resistant strains. We canmake a change in thinking with practice of few good ideals as ………
  2. 2. 1 Make use of suitable range of diagnostic, investigative and/or monitoringprocedures when undertaking investigations, which can give optimal, careof the patients.2Communicate complex and technical information to patient’s, colleaguesand those with limited technical knowledge in terms that facilitateunderstanding of issues.3 Accept the responsibilities of the role of the scientist-trained person inrelation to other health care professionals and with empathy and sensitivityto patients, and families.4 Ensure validations of data, through use of appropriate sources ofinformation including relevant databases and consultation with seniorcolleagues.5 Use laboratory Information Technology,WHONETsystems for handling,processing and storage of patient data.CLINICAL EXPERIENTIAL LEARNING The recommended examples of clinical microbiology learning are • Prepare a portfolio of significant clinical cases reported in your hospital and be able to list clinical outcomes and main learning points. • Participate in multidisciplinary review meetings at which bacteriology and other diagnostic results are presented as part of the clinical record. • Critically appraise the internal quality control and external quality assessment of different routine bacteriology methods and draw conclusions about method performance and quality. Our Postgraduate Students should be, familiar with • The clinical impact of important bacterial and viral infections and of the appropriate clinical and laboratory investigations. • The interpretation and reporting of laboratory results in the context of important bacterial and other Microbial
  3. 3. infections.• The partnership between the clinical microbiology laboratory and other clinical specialties in the investigation of common bacterial infections. As we are aware many specimens sent to Microbiology are sent for Histopathological and biochemical examination too, our constant touch with our colleagues makes our reports acceptable and causes no confusion among the Clinicians. • Perform and critically evaluate the results from a range of assays used toinvestigate viral infection including: immunoassay; agglutination; immunofluorescence; neutralization; Immunoblotting, electrophoresis and gel diffusion. Many rapid tests we do in the laboratory are inconclusive, and may not be specific, and Microbiologists should accept the limitations and try for better and newer generation of tests, or else we become static in progress of the patients care. • Clinical practice guidelines if followed by Clinical microbiologists, have several potential benefits, including better patient care at lower costs and, when applied properly, the potential to protect health care providers from legal claims. There are several potential reasons we are failing to follow, many standard guidelines, due lack of coordination at many levels of administration, resources and funding crunch as in most of the Developing countries. Still we can do better beingaware of clinical practice guidelines. It is not surprising that clinical microbiologists might not be aware of a specific aspect of clinical practice guidelines.Many of us are confused with different conflicting interpretativecriteria; there are over 1,000 clinical practice guidelines in theNational Guidelines Clearinghouse database, all of which makerecommendations that directly affect laboratory practice. • Overcoming the challenges, remains a challenge to all upcoming Microbiologists, until the Medical fraternity
  4. 4. realizes, Microbiology is not anarmchair job as in the past but activeLife Saving Clinical Specialty.Kindly write back your feedback, suggestions and commentsso we can formulate and spread the better ideas to developClinical•