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“He wanted my semen!”
A medical technologist (MT) is an allied health professional who battles the forces of evil, standing up against the stink and slime and does clinical laboratory diagnostic analysis on human blood, urine, body fluids (mostly semen...gallons of it), and other specimens such as stool and sputum, in addition to performing other types of medical testing. A medical technologist can also be referred to as a clinical laboratory scientist (CLS), clinical laboratory technologist (CLT), "Hey, you in the lab coat," or medical laboratory technologist (MT, not MLT), which should not be confused with a medical laboratory technician (MLT). Medical technologists must hold a four year bachelor's degree with a major in Medical technology (Clinical laboratory science) or a four year degree in a life science, in which case certification from an accredited training program is also required.
In the general population, and even among most medical professionals, there is much ignorance and confusion surrounding what a medical technologist is and what a medical technologist does. Biologists have yet to observe two med techs mating in their natural habitat, the laboratory, and they do not survive in captivity. This widespread confusion results in many myths and misconceptions about these strange creatures which will be dispelled here.
edit Role in health care
Most people have personally experienced the following process. You get sick. You see a physician. The physician writes you a pharmaceutical prescription and orders lab work based on your presenting symptoms. You go to the pharmacy and fill your prescription, and either go to an outpatient lab center, or give some blood samples for the lab work in the doctor's office. In time you return to good health. You see your physician for a follow up appointment to ensure you have recovered. At this appointment, the physician generally spends time flipping through your patient chart and medical records. This paperwork contains the results to the lab work he ordered at your original visit. An inquisitive person will ask the following rhetorical questions. Who collected my blood samples? Where did my blood go? What blood work or tests were performed on my blood? Who did the actually testing? How did I get crabs twice in four months? What were the results to the lab tests? Were my results normal or abnormal? These questions show how the medical technologist is a critical link in the chain, and some might say one profession in an army of unsung heroes in the healthcare professions.Often, the med tech must strictly enforce rules, regulations, policies, and guidelines. This can be a source of contention with nurses, the med tech's arch nemesis and rival. These rules often seem arbitrary, bureaucratic, and meaningless from the nurse's perspective. However, all these policies, as strange as they may seem, are designed as redundant fail safe systems to protect the patient's health. Often, a nurse's common sense is in complete contradiction with lab policies. These policies can be time consuming, monotonous, and repetitive, but they do ensure patient safety.
Med Techs must also prevent patient deaths due to evil doctors and nurses (evil being redundant of course). Most doctors are complete quacks and could easily "off" a patient on a bad day, many more on good days. Nurses have no other role, besides hardcore pornography, but to make truly ill people feel even worse. In any given hospital one can find med techs locked in mortal combat with nurses, their arch rival.
edit Nomenclature: medical technologist (MT) vs medical laboratory technician (MLT)
All the different names used for a medical technologist is one of many sources of confusion surrounding this profession. Besides being called clinical lab scientist, clinical lab technologist, and medical technologist, they are often referred to as "lab techs" or "med techs." This shorthand term has been deemed appropriate and acceptable by all healthcare employees, including medical technologists. However, the term med tech is the major contributing factor to much confusion in the medical field. There are many "techs" in a hospital environment. These being pharmacy techs, respiratory techs, and x-ray techs. In these instances "tech" usually refers to a technician. While the general population would see this as semantics and would assume that the terms technician and technologist can be used interchangeably, there is a major distinction between a technician and a technologist. A technician generally holds a two year associates degree, has completed a certified training program, or fucked most or all of their community college professors. A technologist, on the other hand, holds a four year university degree and has been certified by a national credentialing agency. Unfortunately, this leads many healthcare professionals, mainly doctors and nurses, to not view med techs as being on their own levels of authority, respect, status, and prestige. In the laboratory medicine field of healthcare, the medical laboratory technician, or MLT, is a career in which one has completed an associates degree program. Thus, truly, the MLT should be referred to as the med tech, but this simply is not the case. Generally, a medical technologist is called a med tech, and a medical laboratory technician is called an MLT.
edit The organization of the clinical laboratory
A med tech falls into the following hierarchy of the clinical laboratory. From highest authority to lowest, the scale would be as follows: pathologist, pathologist assistant, laboratory manager, department supervisor, chief technologist (lead technologist), cytotechnologist, medical technologist, histotechnologist, medical laboratory technician, lab assistant (lab aide), phlebotomist, transcriptionist, specimen processor (secretary), and finally, gimp.
edit Med tech specialty areas
A med tech can become specialized in a specific area of the clinical lab through additional education in a specific subject area. These areas of specialty are microbiology, immunohematology (blood bank), immunology, hematology, urinalysis, coagulation, clinical chemistry, toxicology, virology, cytology, and cytogenetics.
edit Medical technologists in popular cultureMedical technologists are not represented in popular culture. A major reason why most people don't realize this profession exists is due to lack of representaion in the mass media. Medical technologists are never portrayed in television programs or feature films. The medical technologist profession is not as "sexy" as dramatized doctors and nurses. From M*A*S*H to ER to Scrubs to Grey's Anatomy, the only depictions of anything lab related usually consists of a main character, generally a doctor or a nurse, walking into a dark empty room (the lab) with some type of patient specimen, turning on the lights, sitting down at a microscope, and then making his or her own diagnosis. This simply could not be further from the truth. A fair percentage of the time, the typical involvement of a doctor or nurse generally consists of sitting at a computer (growing their fat ass) and entering in the lab orders into the hospital computer system. Then, a phlebotomist collects the specimen from the patient and transports it to the lab. Here a specimen processor accessions the specimen, prepares it for testing, and delivers it to a medical technologist. The medical technologist evaluates the quality of the specimen, performs the requested test, reviews the result, and releases it into the laboratory computer system. It then prints off a printer at the nurses station for that corresponding patient where a doctor or nurse retrieves the piece of paper, interprets its significance in the context of the overall state of the patient, decides on a diagnosis or treatment plan based on the result, and places the lab result in the patient's chart. Clinical laboratories are generally buzzing with activity 24 hours a day, seven days a week, 365 days a year. The lab is never empty, the lights are never off (unless someone's getting a blowjob), and it is never closed. The only claim to fame as far as seeing a med tech portrayed in showbiz would probably be Klinger on M*A*S*H, and he would just be holding a tray of patient specimens for the lab. Thus, med techs only real representation was a cross dressing, big nosed, hairy immigrant from Toledo, Ohio.
Now, some might argue that recently there has been much interest in the lab, especially on television. This is due to the current CSI series. The laboratory professionals represented in CSI are glamourized and glorified forensic scientists and perform different job functions than the med tech. Med techs provide testing for healthcare purposes, not criminal investigative work. However, real life forensic scientists will attest to the fact that these shows are grossly inaccurate in their portrayal of crime labs.
edit The med techs place in the hospital
The clinical laboratory is rarely ever mentioned on any hospital's official website or even in internal hospital newsletters for employees. Meanwhile, all other departments and services will be recognized. For instance, the chapel, cafeteria, radiology, pharmacy, the laundry, "environmental services", etc. However, no one ever notices the inconspicuous absence of the lab. An additional reason why med techs are not highly visible in a hospital has to do with architecture and real estate. When an architect designs a hospital, the valuable real estate goes to the patients and hospital bureaucrats so that they can have rooms and offices with a window to the outside world. This would be considered beach front property. Thus, the architect pushes the workplaces for the common workers into the less desirable internal areas of the hospital. In these fluorescent lit boxed in rooms one will find the dietary and nutrition services, laundry, radiology, and the clinical laboratory. These are not high traffic areas and most patients and visitors will never see these areas of the hospital. Surpisingly, many hospital employees ranging from volunteers to medical doctors don't even know where the lab is and often confuse it with the cath lab or the outpatient draw station, where blood is collected for the lab.
The face of the lab is the phlebotomist. The phlebotomist has the most difficult job duties in the hospital. They must enter a patients room, wake the patient from sleep, ignore their raging hard on unless it's a woman in which case they fondle her breasts prior to waking, identify the patient, explain the procedure to the patient, stick a needle in their arm, collect the blood properly, label the specimen properly, bandage the patient, end the conversation with the patient, and move on to the next patient. However, only a few months training is required for the phlebotomist to be certified. They are often only high school graduates and thus at a lower socioeconomic status than most of the other healthcare professionals they must interact with. This leads many nurses and doctors to create a stereotype of all lab employees being uneducated simpletons. It is also a common misconception of nurses that eventually a phlebotomist will become a med tech through on the job training. This is akin to assuming eventually a nurse will become a physician. These are all separate and distinct professions that require training, certification, and licensing.
edit The med tech personality or lack thereof
One more way to explain the mystery surrounding the med tech profession lies squarely on the med tech's shoulders. Just like Type A and Type B personality classifications, med techs are generally quiet and introverted. Their interest in the scientific side of health care distinguishes the profession as opposed to nurses who may enjoy talking to and touching patients regularly (bondage and sadomasochism). Thus, med techs may not be as vocal when it comes to hospital inter department meetings and other facets which may steal attention and resources away from the lab.
As most med techs are naturally quiet and introverted they also tend to be introspective. This could be due to their natural mental composition or all the timers they stare at waiting for centrifuges to stop or 5 minute pregnancy tests to develop or a combination and collision of both these facts. As the med tech sits there waiting for a CBC to print off or a urine strip to be read his mind naturally wanders to deep, profound, and very often perverse thoughts (but maybe that's just me). Med techs stare into space or at a wall or at the floor with a peaceful resignation that there really is no hope and their own life is completely out of their control and life is simply chaos and random events. They have a calm demeanor and are a defeated people. They gave up long ago and now live a life of quiet desperation constantly discussing thier vacation time and 401(k) and a retirement that they know will never come. Pessimistic?...yes. But I fucking love those poets and philosophers of the lab. Med techs are not like nurses whom distract themselves with inane conversation about weight watchers as they consume massive amounts of calories before 11 am and never get tired of discussing their latest orthopedic foot wear. While most healthcare workers live in some fantasy world of their own making, med techs are planted squarely in the real world of despair, truth, pain, and reality. Med Techs can often be sages, gurus, and mystics. From the lowest IQ housewife fucktard med tech to the genius shining beacon of the industry, if you can translate what they said into what they actually were trying to convey, or if you just meditate on their words long enough, they can blow your mind and change your whole paradigm and transport you to a whole new universe.
After decades of oppression by other healthcare professionals, med techs have developed serious self esteem issues. Med techs don't feel they deserve to be loved. Just like Tina and Ike's abusive relationship, the nurses are in a cycle of "throwin' a beatin'" on the med techs and then saying, "Baby, you know I love you. If you take me back, I promise I'll change." The med tech always takes them back. Their poor self image can be seen physically manifested by walking into any clinical laboratory. The equipment is old and broken. The walls, floors, and benchtops are worn, much like the med techs psyche. It's like stepping into the 1970's but without the shag carpeting and oranges and greens. Newly graduated new hire med techs notice the decrepid conditions at first, but after a year or two they become so accustomed to the poor working conditions they no longer see the absurdity of it all. "Oh, this centrifuge lid doesn't quite work? No problem. This microscope doesn't quite focus. I'll just squint." This is also due to the fact that patients never see the lab. The hallways, patient rooms, and cafeteria may be shiny and new, but the lab is literally falling apart.
edit Healthcare fads
Popular medical treatments and tests come and go over time. Hospital budget dollars generally go to the latest and the greatest new trend that patients are looking for. This could currently be MRIs, CAT scans, nutritionists, etc. Perhaps a new diagnostic lab test will be developed that will be hip and cool and the spotlight will shift to the lab for a time before shifting again.
edit Evolution of the med tech
Over the years, due to malpractice lawsuits and hospital insurance premiums, more and more decision making, authority, and responsibility has been shifted from the med tech to the pathologist and lab department supervisors. While things are going well, med techs will complain about their powerlessness. When things are going poorly, in the case of mistakes in the lab, the med tech is quite content being protected from blame. Some claim the med tech has gone from a healthcare professional to a common laborer akin to an assembly line factory worker. Whereas in the past the med tech drew on a vast general knowledge of science and medicine to measure specific analytes for a specific patient, now, the med tech relies more upon a kind of flow diagram logic or in some cases a literal flow diagram, which is completely unreadable. If the answer to this is yes, do this, if no, do this, and on to the next step, etc. until a clinically significant result is obtained or the last step would be to call the pathologist for assistance. This is often referred to as "cook book chemistry" or "kitchen chemistry." The med tech just follows the "recipe" or process to perform the test. Advancements in technology and automated instrument testing has also replaced most of the knowledge and independent thought required in the past by med techs.
edit Med tech unions
Med tech unions are virtually nonexistant. In some cases med techs are unionized or are allowed into the nurses union, however this is extremely rare. This is apparent at every election cycle when nurse and physician unions endorse political candidates, but not med techs. Privately operated reference labs are always willing to have the business of a hospital laboratory. In some cases hospital labs are contracted to an outside lab such as LabCorp or Quest Diagnostics. The hospital could even send its specimens across town to the reference lab by courier and only operate a stat lab on the premises for truly critical patient tests. Thus, if med techs did try to unionize and negotiate higher wages or other benefits the hospital could simply sell off the lab. Most hospitals are already looking for ways to cut costs and the lab is usually an area of expense so unionizing would probably push most hospitals to contract out the lab rather than have to deal with an organized group of med techs.
The only representation that a med tech has is generally by the pathologist, a medical doctor, or a lab manager, generally a marketing, management, or business major more interested in bureaucracy than the lab employees. Thus, in inter-department hospital meetings the lab generally is walked all over at the benefit of other departments.
edit Hospital phenomena and dynamics
An interesting phenomena that occurs in the hospital is how the med tech has the role of problem solver. If a nurse has a question about a test method, an analyte normal range, or a test result's clinical significance it is appropriate to call the lab and ask. However, nurses also feel the lab is in charge of supply or inventory (those stupid bitches). Nurses often feel the lab is the stock room whenever they need equipment (they're total dumbshits). Also, whenever a nurse's computer or printer malfunctions they usually call the lab and expect the med tech to be able to help fix it. This is all proof that nurses know they can rely on the med tech to get answers to their questions more often than not.
Another lab dynamic is the often contentious relationship between lab staff and nursing staff. This is often due to a perceived or real disconnect between bedside nurses and physically separated med techs. While nurses and doctors work in an often high pressure work environment such as the ER where patients can be gushing blood, projectile vomitting, ejaculating, or having a massive stroke, the med tech is insulated from all chaos in the lab. Thus, the med tech can often seem perturbed by an overly excited or curt phone call. This is similar to the motion picture The Blues Brothers. At the end of the movie the entire might of the US army is bearing down on them and when the camera cuts to Jake and Elwood they are calmly riding in the elevator with elevator music playing in the background. Another facet of this dynamic is that the ER and most nursing stations are staffed by a unit secretary. The secretary generally is only a high school graduate with no real understanding, respect, or awareness of all the healthcare professions except what they absorb from the nurses and doctors around them. The unit secretary is often mistreated as he or she has no real status or power and feels unable to defend herself when a doctor is rude or a nurse is insulting or condescending. Thus, after a long shift of internalizing all this hostility, frustration, and rage the unit secretary often vents this pent up negativity on the anonymous person on the other end of the phone, or the med tech. Doctors get a free social pass in hospital etiquette as is often depicted on television and other media. Obviously, this is all total bullshit. I mean puhlease.
Can you say passive aggressive? I knew you could. As in any "healthy" relationship, mental abuse and antagonism is par for the course. How else will you ever get around to make up sex? Seriously, that shit is so hot. Who doesn't love total abasement, humiliation, objectification, and submissiveness? But getting back to the subject at hand, med techs don't feel loved or appreciated by their peers. Thus, they resort to negative emotional tactics as a means to being fulfilled and at least feeling something. Maybe med techs purposely delay results just to get a reaction from nurses. Maybe it's a power struggle. Maybe med techs are trying to teach nurses a lesson. Maybe they are screaming for attention. Maybe they are trying to prove their worth and value and necessity. Maybe it's all a game. Maybe I've been watching too much Oprah and Dr. Phil. Maybe with delayed results med techs are saying "Hello. I'm the gate keeper here. I've got what you need. Helllooooo. I'm totally important. I totally deserve your respect. Heellllloooooooo."
edit Education and state licensing
Approximately 15 states require a state license for med techs to be lawfully employed. Some of these states are Hawaii, California, Florida, Nevada, and Louisiana. These licenses generally involve filling out paperwork, paying the state a $100 fee, and showing proof of certification by a national accrediting agency. Only California requires passing a state administered examination. National certification as well as state licensure require annual continuing education credits.
In most four year degree programs the student attends classroom based courses for 3 years and spend 1 year doing clinical rotations through the different disciplines of the lab in a hospital. This consists of hands on diagnostic testing under the supervision of hospital employees. The student works 40 hours a week for 20 to 26 weeks without pay. This would be considered a 3+1 program. There also are 4+1 programs with one-year medical technology internships (in Michigan, for instance). There are also 2+2 programs.
edit Job duties: If unsure, mumble, when you don't know, delegate
While anyone could load the specimens onto the automated instruments, press go, and enter the numerical results into a computer, a med tech monitors, screens, interprets, trouble shoots, and ensures the numerical value results are clinically significant and useful to the diagnostician who bases patient treatment decisions on these lab results.
Med techs take pride in causing nurses, doctors, and most other hospital staff as much trouble as possible. If a med tech makes it through the day without pissing off or even mildly annoying a peer or coworker, that day is considered a failure. It's kind of like the movie The Great Escape with Steve McQueen. Just like the prisoners of war considered it their duty to keep the Nazis as occupied as possible, med techs must confound and instigate the nurses in order to prevent them from so called "healing" their patients.
There is often more than one way to measure an analyte such as glucose or potassium. The med tech may have to choose a specific methodology based on the patient's diagnosis to avoid interfering substances that may affect one method but not another. Any test can produce false positives or false negatives.
The med tech must also discern when a specimen has been contaminated or has been collected improperly. Blood can be drawn too near an IV line in a patient's arm and the specimen may be contaminated with IV fluid. Some specimens must be placed on ice while in transit to the lab, while others must maintain body temperature. The med tech must recognize any and all possible processes that might introduce error into the final result.
Also, specimens can be mislabelled with the wrong patients name. A med tech must try and catch these mistakes before lab results are reported for the wrong patient. When this does happen, it is referred to as an "oops" or "whoopsy daisy" (except when the mistake is made by the lab, in which case he is fired just before being drawn and quartered).
edit Common tests performed by med techs
Common tests performed by med techs are complete blood count (CBC), liver function test (LFT), prothrombin time (PT/INR), cholesterol, homosexuality, hemoglobin, and activated partial thromboplastin time (PTT or APTT).
edit Powers, abilities, skills, and resources
Med techs have a wide range of superpowers. Their weapon of choice is a squeeze bottle of 10% bleach solution. When battling a "Queen Nurse" or "Level Boss Nurse", they will occasionally increase the potency to 15% bleach 85% distilled deionized water (only the purest water will appease a perfectionist med tech). A concentration above 15% is absurd and overkill and a waste of precious bleach. Med techs can detect even the slightest hemolysis, icterus, or lipemia of a specimen from over 30 feet. In everyday life they can detect your level of plasma lipemia or anemia simply by shaking your hand, although they will never show any acknowledgment or "tell" in their face. While wearing a labcoat, they are invulnerable to copious amounts of urine (except for nurse urine) no matter how much you throw at them. Unless of course, you are actually urinating on them. The lab coat and latex gloves are probably the most important parts of the med tech costume/disguise. Once they put them on they are given a feeling of invincibility.
Obviously, med tech kryptonite is nurses and short draw specimens. The med techs major weaknesses are sputum and stool specimens. An especially viscous sputum can instigate an irrepressible gag reflex rendering the med tech vulnerable to a "nurse sneak attack." A particularly "stanky" bloody stool specimen can knock them out temporarily. However, they may also use the "stankiness" to keep enemies at bay outside of the hood (no, not that "hood," a ventilating hood). Another major vulnerability are latex allergies. The general consensus is nurses are somehow responsible for it. Finally, OCD, or obsessive compulsive disorder, is a common attribute and weakness of most med techs. It is fascinating to observe them in their natural habitat constantly rearranging their bench space. While a med tech is on his or her lunch break, a fun game to play is moving their stapler or other items and watching them move everything back when they return. This is akin to the Bower bird where the male of the species will create an intricate structure with many specifically placed blue objects around to attract a mate. The med techs OCD has no apparent beneficial function and it is probably a defect in their basic makeup. How many times is too many times when you are wiping down the phone with alcohol wipes?
Most med techs display their OCD behaviour particularly in hand washings such as 20 step hand washings, repeated hand washings before lunch break and after work. Most of them are obsessed with keeping lots of different brands of ink pens in their lab coat pockets as pens are frequently "stolen" in the lab. Sometimes it ends up in other's coats or places they have been to. It is thus a normality to see pens (and occasionally penises) with names on them. The most sought after pens are "click pens" which can be deftly removed from one's pocket, clicked with a thumb of the same hand, swiftly brought to bear for insane amounts of initialing clipboards full of lies (trust me, you don't want to know), clicked again to retract the ink tip, and gracefully returned snugly to it's home close to the heart. The preceding action is one of the greatest feelings in the world. When you click that pen and slip it back into your pocket hooking the pocket with the pen clip you really feel a sort of zen peacefulness and a sense of accomplishment. It's like all is right with the world or you just shot your load. You kind of sigh and feel a little tingle of endorphins rush through your body. GOD, I CAN ALMOST FEEL IT RIGHT NOW! Rookies will struggle with cheap bic capped pens, constantly uncapping and re-capping with TWO HANDS!!! Yikes. I mean, it's really pathetic. I mean, c'mon. Now, a minimalist (and by minimalist I mean heterosexual male) Med Tech will only carry a click pen and a permanent marker in his chest pocket. Preferably, a black or blue ink and none of that fruity light blue or turquoise blue but a nice masculine dark or navy blue. I am currenty unaware of a clickable permanent marker, so for now, when you're needing permanence, one must use two hands to uncap those sweet, sweet sharpies. Don't get me started on my love of the smell of gasoline and sharpies. But mark my words, when that day comes, and the clickable sharpie is available in a store near you, we are gonna take it to a whole other level. They may exist, but perhaps the cost is prohibitive. Diving deeper we could discuss the art of handwriting analysis, discerning the letters of med tech initials, and memorizing everyone in your department's initials when investigations of snafus occur, but I'm just not in the mood eh? Med techs all come to know their mortal enemies initials and are filled with soul poisoning anger when they spot them. Let it go dude. Move on. They're not worth it. You're better than that.
edit The med tech shortage
Currently, the United States is experiencing a labor shortage for med techs, as well as virtually all other healthcare positions. Thus, not only are labs short staffed, they often are forced to hire incompetent med techs. Whereas a lab manager would like to have a large pool of applicants to select the most qualified and competent one, instead, a lab manager will go months without a single applicant. When someone does take the bait and submit a resume and application, the lab manager would rather have a warm body filling a position than nobody at all. This is all due to lack of interest in the profession at the university level. Student enrollment in med tech programs is steadily declining. Thus, universities cut the budgets for the clinical lab science programs if not closing them altogether. Universities, like most things, are run for profit and if the students want to be nutrionists and not med techs, the university shifts budget dollars and class and lab space to the nutrional science programs and away from the med tech programs.
Med tech breeding programs have been largely unsuccessful to date. They barely survive in captivity let alone breed. Homosexual med techs don't do anything but breed...seriously...it's gross (except for two hot lesbos! Yay, I could watch that all day!). Obviously, gay breeding activities don't produce viable progeny. Scientists have tried artificial insemination without much success. The male med tech is more than happy to be "milked" by breeders, but it has been recently postulated by leading scientists in the field that female med techs somehow incapacitate the spermatozoa with 10% bleach solution. Female med techs are more than willing to breed with doctors. The leading theory is the size of the doctors wallet is directly proportional to her willingness to breed. Oddly enough, phlebotomists breed almost uncontrollably. There are often third and fourth generations living together. Please help control the phletotomist population. Have your phlebotomist spayed or neutered.
edit Position title and abbreviations
Medical technologists are entitled to use the credential "MT" after their names, similar to MD (only a lot funnier) for medical doctor and RN for registered nurse or "real nasty." Those certified by the American Society for Clinical Pathology may use "MT(ASCP)". Additional certifications may also be used, such as the "SBB" (Specialist in Blood Banking) certification from the American Association of Blood Banks accredited programs, or "H" (Hematology) or "BB" (Blood Banking). BM is an abbreviation for bad motherfucker. These can be appended to the credential, for example, "MT(ASCP)SBB". Though regardless of the number of degrees, certifications, and letters behind their names, med techs still get treated like turd blossoms by the nursing staff who themselves have two-year degrees from institutions of questionable quality.
In the United States, the Clinical Laboratory Improvement Amendments define the level of qualification required to perform tests of various complexity. A medical technologist holds the highest such qualification, and is in general qualified to perform the most complex clinical testing, such as human leukocyte antigen (HLA testing (tissue-typing) and blood type) blood type reference testing.