Celebrating Lab Week: Looking at the Past to Plan for the Future

(inquisitive electronic music) - This is "Lab Medicine Rounds," a curated podcast for physicians, laboratory professionals, and students. I'm your host, Justin Kreuter, the bow-tie bandit of blood, a transfusion medicine pathologist at Mayo Clinic. This year's theme for lab week is "Back to the Lab," celebrating our past as we look into our future.

So we thought it'd be fun to celebrate this year's theme by sitting down with one of our laboratory leaders to discuss why it's important to look at our past when planning for the future. So today joining us is Dr. Curt Hanson, profess of laboratory medicine and pathology, a hematopathology consultant here at Mayo Clinic and executive vice president and chief medical officer for Mayo Collaborative Services. So thank you for joining us today, Dr. Hanson.

- Oh, you know, I first saw your invitation, I thought Justin's looking for the oldest guy he can find to add to his calendar here. So thank you for asking me by the way. - Yep. Our audience is looking for the wisdom, and I know you've got it in spades for us today. - We'll try. We'll try our best. - So from a leadership perspective, as I did your introduction, you know, you really have a lot of leadership roles, and certainly you've served for a number of years in a number of different hats.

You bring a lot of different perspectives

to laboratory medicine and leadership. And so, you know, why is it important from your perspective for us to look at our past when planning for our future? - That's a great question. I think that one of the first things that comes to mind is it's an opportunity to re-look at and validate what our principles are. Too often, we just keep going down the path. We're busy, you know.

We do today, you go to today's list, and you do today's list, and you worry about yesterday's things you didn't get it done. And we don't take the time to really sit back and reflect on what's my vision, what are my principles? And am I upholding those? Are they still valid? Do they still work for us? How can I incorporate them more into what we do? And I think by looking back, you can really go, "have I been cons consistent over time?

Have we been consistent over time with why we do what we do?" And I think that's really something we don't spend a lot of time thinking about, but that really should drive what we do. It certainly should drive our decision making and our planning and our prioritization of things. The other thing that comes to mind and is pretty, I think pretty obvious is you need to always look back to see what worked and what didn't, but you gotta be careful, because times change.

I'm involved in a situation right now in which I'm looking back to how and why we did things many years ago and kind of going, I'm consistently going, "what worked, what didn't work back then, but then what's changed?" And I think that's, what's really, really critical is, people always say, you don't wanna repeat your errors from before, but I think what you gotta remember is that the situations change and you have to interpret yesterday's either decisions

or failures in light of what you know today. And I think that's a really important thing with it all. You know, change, it comes with change, right? I mean, change is such an important thing of what we do and we can't be scared of change. And I think by thinking about principles and vision and what you've done in the past, there's been seldom that I've run across something that I haven't encountered in the past in some variation or version with it all.

The last thing I'd probably say is you need to take time to look back and celebrate, especially if we got lab week coming up, think about how hard we press, Justin, on trying to get everything done, everything we do. We need to set back a little bit and kind of go, think back a year, think back two years, three years. And everybody, if they took the time would go, "wow, look at how much we've gotten done. Look at what we've accomplished."

And I think that we need to make sure we, you know, don't be hard on yourselves or ourselves. Let's look back, be proud of what we accomplish, celebrate our accomplishments, because that keeps you going for the next year if you can find that sense of accomplishment. I hope that makes sense to you, Justin. - Absolutely! I really like how you're highlighting, what I'm hearing is that change is this constant.

And if I can paraphrase, it almost sounds like, you know, there is natural, a drift that may occur and so that we wanna make sure that the changes that we're making are purposeful. And I think I hear you highlighting this kind of, how do we kind of reflect on, we need to take time to critically reflect, and I like that you're asking, pulling out that third question, not just, you know, what did we do well, what did we not do so well, but also the what's changed?

'Cause I think a lot of us, myself included, aren't necessarily thinking about that third question and certainly context in some ways

might be one of the best drivers of learning. - Well, just, I mean, think about, you know, policy, finance, people. How the people have, you know, are different and changed. And you know, our knowledge is clearly different today than what I might have been five, 10, certainly 20 years ago. - You know, let me just play, we're just kind of sticking in this kind of getting things off in the why focus.

I think I've heard some people sometimes, if I'm to play a little bit of devil's advocate here, kind of like about your purpose of celebrating our successes and celebrating the work we've done. I completely agree with you, but I think there's some people sometimes that feel like, well, "hey, this is my job.

And, you know, I shouldn't, you know, that's good that I'm doing my job," but sometimes people struggle with celebrating, and I think also maybe some people, you know, get nervous about that taking time to celebrate our accomplishes that have been. What's your perspective on that? - Well, I mean, it's a part of being a person, right? I mean, there are, you know, there's all types of people that we work with. There are people that, you know,

they just put their head down and it doesn't matter their degree, their title, whatever it is, boy, they just, they work, they come in every day, they work really hard, they don't want kudos, they just wanna do their job and do it. And there's others that, on the other end, there are people that need motivation and that's normal. And I think it's our job as leaders to use whatever tools that we have, like this looking back and reflecting on accomplishment to keep people motivated.

And then the majority of people are in between. You know, we've got folks that really always wanna work, but, you know, we need to make sure we take a little bit of time to celebrate them, to thank them. And that's what lab week is great for, right? I mean, I think it is a time to sit back and really kind of go, "wow, what a great profession we work in and the people that we have." And it's a wonderful time to be able to do that, Justin. - Thanks for keeping the humanity in it, right?

We're patient centered, but keeping the humanity in our work is key. So what are one or two aspects of pathology lab medicine's past that you are thinking about celebrating this year? - What's that, let me think. You know, there are two, I have two stories. I got two stories I gotta share with you. - Stories are the best. - You know, I'm in the, as I tell people, I'm partway, I'm a good portion through the fourth quarter of my career, so I'm entitled to reminisce a little bit, okay?

When I started, I started at the, my first job was at the University of Michigan, 1987. So you can do the math. And a senior laboratory director at that time who I really respected, he came to me, this was very early on in my time there. And he said, "Curt, during your career, you're gonna see two changes in technology."

And that was being really forward thinking, because that was going, "wow, you mean every 15 years, I'm gonna go through two major changes of technology and knowledge," and that was really being kind of forward. And now it's like, "good Lord, it's every 15 months, there's something new."

And, you know, I was just, I actually was talking to a patient this morning and they had a very problematic history, they had traveled to Africa, came back with symptoms that were really different to define, and eventually ended up here at Mayo, and we did our workup, turned out to be a hematologic disease, they did the genetic workup, and they found some really unique findings by doing NextGen sequencing and understanding the gene anomalies that were discovered.

And that technology was barely going five years ago, the knowledge about these particular genes has just emerged in the last couple of years. And I think that that patient's experience was, you know, he came here in 2020, he wouldn't have had the same experience in 2015, let alone 2010 or 2000 or 1987 when I started. So that pace of change is something that is really amazing to me. And I think our folks in the lab see it, but we really need to acknowledge that it's both good and bad, right?

I mean, it allows us to take care of patients in amazing ways, but it also puts a lot of pressure and stress on our staff, because there's always something new coming at 'em. You know, that type of thing. So that's one story that will always stick with me and I laugh about it now, but at the time it was like, "wow, you know, two? I'll go through two changes," you know? And like I said, that was two last year, I think, if I remember right.

The second story was I started residency in lab medicine pathology up at the University of Minnesota almost pretty soon 40 years ago in 1982. And I remember this to this day, that my first lab rotation, everybody starts on off in autopsy, you know? So my first lab rotation was in the clinical hematology laboratory. And I remember, I walked in, I was what? I don't know, 25 and green. I looked like about 18, just off the farm, you know, that type of thing.

And I looked around the lab and I thought, "oh my God, these people, these texts are going to eat me for lunch." You know, because they were so impressive. They knew everything. They were working hard. They were organized and I swore that day, I really, I said this to myself is, "I gotta get in their good graces

or I'm gonna get killed here." And that was my first lesson in, you know, our best asset are our laboratory technologists, our clinical laboratory scientists. They are incredible. And I learned so much from them. Every day I learned tidbits of knowledge. And very humble, and they would just say, "Dr. Hanson, I think you ought to do," da-da-da-da-da. You know, words of wisdom, you know, type of thing. And to this day, if you need to know something, walk through the lab and ask the techs.

When there's a problem, they know it, they know where the problem is coming from. They know the problem docs out there. They know the great docs out there. We don't ask our CLS, our lab folks, enough questions because frankly, they're are biggest asset that we have and they know so much. And that's the one thing I don't want us to ever lose. I saw it in day one of me walking into this profession and it's still true today. - Those are wonderful stories.

I mean, so it sounds like you're celebrating the pace of change, the history of the pace of change that we've had in laboratory medicine, and then the quality of people that are attracted into this profession of medical laboratory science. So how do you see these aspects that you're celebrating informing kind of the future, you know, kind of the future projections of success in our field?

- We have to be ready for change, and I think there's actually, there's a lot of discipline out there that has been, and you know this Justin, that's been developing. I mean, you've been a part of that, that's been developed over time about how do you deal with change? How do you make change successful? How do you incorporate change?

And I think we really, we need to move beyond some of our historical approaches to things and really kind of grab that discipline of change and really drive it in the laboratory and challenge how we do things. Think about how we organize our laboratories. They're either by technology,

or they may be by a particular medical discipline, and we should challenge the heck out of, and go back to what I just talked about with that NextGen sequencing and genetic things, how much that's changed how we work out particular things. I think we really need to challenge ourselves as part of this change process. How do we organize ourselves? What is the right way to put a lab together to maintain it for the future, to get the most, you know, medical and scientific knowledge out of it.

And I think the second thing is gonna be right off that story that I told you. Our people are our assets. Period. Straight up. We don't always recognize that, we certainly don't celebrate it enough, we don't ask enough of them. I have, what I've always found is that you can't get something out of people if you don't ask something of them. And I have seldom found laboratory people if by asking them to do something, seldom do they not achieve it. We just often don't ask enough of them.

I mean, not working harder, but how to use their head and their brain and their problem solving and all that type of thing. I think that looking back, that's the one thing that's been constant is the skillset of our people and therefore the need to really recognize and include them in the process here going forward. Hope that makes, I'm rambling a little bit, I hope that makes sense, Justin. - No, this makes perfect sense.

And I see, you know, this kind of thread continue about really questioning these assumptions that we've come through, but as you're talking about this constant of the quality of our team in the lab, I've heard a lot of, you know, it's a challenge in current days to attract, you know, new people into this field of laboratory medicine.

Do you think that there's, do you have thoughts for how we might approach this, you know, as a healthcare system of attracting, you know, bright students into medical laboratory science? - I often use the analogy that we're like the Wizard of Oz. We're the man behind, the man and woman behind the curtain and everything turns to gold, right? But they never know who's behind the curtain. That's the lab. They never see us.

And if there's anything we need to do, we have to figure out how to really erase some of our invisibility that we have. Getting ourselves more visible is really, probably the most important thing. And that means visible not only to future employees and students or colleges, but also in our own institution. You know, I don't know if you've noticed here at Mayo,

Justin, but over the last year or so, we have been really successful at putting out laboratory studies into our weekly, you know, the Mayo newsletter that comes out on Friday, you know, electronic, you know, but whatever it's called Mayo This Week, or whatever it is, look at how many lab stories are showing up in that thing every week.

I have heard so many people from non-laboratory areas say, "wow, the laboratory is really impressive!" So I think we really need to figure out collectively as a, certainly as a profession, but also at the local level, how can we make ourselves more visible locally? And then I think that by itself will help land to that next step.

If we get used to being more visible locally within our own organizations, we can become more visible into those, you know, whether it be educational areas and locations or other just in general within the community. I think visibility is obviously the key and we go into it with one hand tied behind our back because we do things so well and we do it in such an invisible way. We just get asked and we do things.

- Mm hmm, and what I hear too in your answer is, you know, with visibility, it's not just a one and done sort of thing, but your answer kind of talking about, you know, how many of these stories have made it into Mayo This Week, right? So it's not just showing this once, but we're continuing to share these stories so that our community continues to see, and to use your words, erase the invisibility of the laboratory. - Absolutely. Really critical.

You know, and this is a challenge all across medicine. It's not just the laboratory. You know, and COVID obviously has done nobody any favors in so many ways, but, you know, I think healthcare in general is running into how do you get enough of the right people, enough of the right dedicated people with the right, you know, mission focus, to walk into the jobs that we really need here in healthcare. So it's not just labs.

I mean, obviously we're very parochial in thinking about the labs, but it really extends across all of healthcare. - To flip this in another direction, I just wanna kinda close out maybe this podcast and ask you, you know, certainly as we're celebrating lab week with this podcast episode, you know, there might be something that, you know, certainly we can celebrate it.

You know, we've done our work, but is there something that we've done that maybe we shouldn't continue that we need to change and kind of discontinue a certain process or way that laboratory works? - Well, I think we should immediately stop pipetting by mouth. I think that needs to stop immediately. (laughs) - You're spreading fake news now. - No, no, that is not happening at Mayo Clinic. You're right. I gotta be sure about that.

Actually it was still going, when I started, it was optional in a couple of laboratories, because of the nature of their specimens and then obviously AIDS emerged in the mid eighties and all of a sudden, a lot more knowledge about hepatitis came about and it just stopped. Thank God. It's really an interesting question. I don't quite know how to answer it.

I guess, I wish I had some big overarching philosophical thing I could throw at you, Justin, but I really can't. The thing that probably comes to my mind is I think we're of the, we're clearly a service-oriented profession. We're asked and we give. You know, a lot of times we have the any test, any time, any way you want to it, we'll give it to you.

And I think we really need to, in this era of increasingly limited dollars for healthcare, not an unlimited supply of people, we have to start asking the question of, let's use our knowledge and expertise to say, let's be sure we're doing the right tests for the right reason.

And I think as you look at the horizon and you see the increasing emergence of artificial intelligence or augmented intelligence, depending on what you call it, it's really gonna lend itself to really asking those kind of questions of, let's be sure we're doing the right for our patients, whether it's under testing or over testing, either one.

I think that needs to be the, we need to move from that mindset of any test, any time, to really, let's be sure we're doing the right test and not the one that you want, and don't forget about doing this test, because this is the one you really need. So I think that mentality. The mentality of that, the mentality of visibility, if there were any two things that I'd like to see us, if I look back in 10 years as I sit in my rocking chair, I really hope that's what I see in our profession.

- Yeah. You really have tied this together quite well with that thought, right?

'Cause certainly, that's critically examining, you know, what's our way and what's our practice, and, you know, certainly by making us, you know, how do we shift from service orientation to really being colleagues, you know, equals with our other, you know, healthcare professionals, that's really going to one, help us to be able to advocate for best laboratory practice to support the clinical practice, but also certainly make us more visible as well.

- I'm full of editorials at this time of my career. And one of the things, I don't remember if I told you this when you wrote rotated through once upon a time, but I typically tell my residents when I rotate through is "you are a clinician. You're every bit as much of a clinician as any of our colleagues that we work with across the street. Never forget that."

It's really important, because I think we need to look at now, I'm not talking about, I'm moving beyond the technologists in the laboratories to folks at our level. We need to always think of ourselves that we are every bit is involved with and responsible for and take and care of our patients. And I think that's an important mindset. A lot of these things are the mindsets, I think, that we need to really work on as a profession, Justin, as I look at this. - Excellent.

We've been rounding with Dr. Curt Hanson. Thank you so much for taking the time to talk about this and celebrate lab week with our listeners. - It's been great. What a great time. I can check off my bucket list, I've had an interview with the Bow Tie Bandit. This is fabulous. - That's right! And to all of our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions

via email. (inquisitive electronic music) Please direct any suggestions to mcleducation@mayo.edu and reference this podcast. If you've enjoyed lab medicine rounds podcast, please subscribe. Until our next rounds together, we encourage you to continue to connect lab medicine and the clinical practice through insightful conversations.