Lab Excellence: Spotlight on Laboratory Professionals

- This is Lab Medicine Rounds, a curated podcast for physicians, laboratory professionals and students. I'm your host, Justin Kreuter, a transfusion medicine pathologist and assistant professor of Laboratory Medicine and Pathology at Mayo Clinic. Today we're rounding with Dr. Eric His, chair of the Department of Laboratory Medicine and Pathology at Mayo Clinic in Rochester, Minnesota. Thanks for joining us today, Dr. Hsi. - Dr. Kreuter thank you for inviting me.

This is gonna be a interesting and fun event. - Absolutely. So this episode, we're really kind of continuing this celebration of celebrating the laboratory.

And so I wonder if we could kind of get into this by kicking off with, you know, from your perspective, why is it important to highlight the presence of the laboratory in current medical practice? - I mean, I think it's always a good time to sort of remind people that the laboratory, you know, is, is there to provide, you know, services for our patients. I think the number is bandied about that. You know, 70% of all, you know, medical information comes from the laboratory.

And so, you know, we have a major role in providing data, actionable information to our clinical colleagues to make patient care and treatment decisions. And so with such an important role, it doesn't help, you know, hurt to get in front of people and raise that awareness again that we, we are a part of the care team.

- Right. I like how your answer really highlights this is by maybe playing this role that it's kind, I mean, when you say it's providing 70% of the information, that's pretty substantial. But then also to talk about, it's a reminder, I guess it's, it's easy to kind of be always counted on to be providing these results in a timely fashion. - Oh, certainly. And I, I, I think, you know, I, well, COVID PR was a huge example of getting lab front and center, and it certainly raised awareness.

And at other institutions I've been, you know, the awareness that, you know, at some point in time the laboratory touches pretty much every single patient in their journey. And there's not a lot of specialties that can say that. Right. So one of my colleagues here says, you know, we, we are involved in healthcare from cradle to grave in that actually is to some degree true. - Yeah. So, so that makes me wonder, you know, I'm, I kind of, everybody I think really enjoys hearing stories.

And I'm curious about your story of how you first kind of came to understand and appreciate this extensive role that, that the laboratory plays in medical practice. - That's a great question.

You know, I was, I think there's, people come at it from different, you know, vantage points and I, I was not one of those persons that, you know, grew up and said, oh, I, I, you know, I understand what the laboratory does in a hospital and I, you know, that wants be me or my, you know, my, my parents were not pathologists. 'cause we run into those, you know, those, those types of people too. And I, I came out of more out of a interest in the science background.

My dad was a chemist and, and I, you know, was a chemistry major and I sort of gravitated towards laboratory science, but didn't really understand until really in medical school that the laboratory played an important, you know, role in, in medicine.

And it, and it truly wasn't until I had taken a year off from medical school and did, you know, basic science research and then came back and already then realized like, I really like laboratory and I knew there was a laboratory component in, in hospitals. And so then I decided to do a pathology rotation. Right. And, and because of the research I was doing and I was on, in, in on like part of what they rotated you through was heme hematopathology.

And, you know, that first day I basically knew, oh, that this is what I, I wanna do because my research was in immunology and lymphoid biology and, you know, I was sitting there with a lymphoma expert and I'm like, wow, this is really cool enough. It looks like the light bulb went off. And I then I knew that, you know, pathology, lab medicine was gonna be the way I went. - Wow. - That's a story.

- I think that's a, a nice, nice kind of point to highlight then for our students that are listening about, you know, certainly there are rotations you do in different places, but understand that, you know, Dr. Hsi really kind of came to it from the research angle, I think really helped kind of magnify and put things in focus. And so it kind of, I guess I guess the takeaway from there is to always be open to opportunities and look to connect the dots.

- Yeah. I I think, you know, having an open mind, being curious always will, will help you in, in that regard. - So, you know, now in your role as as chair of the Department of Laboratory Medicine and pathology, you know, you're, you're kind of really in a, a key leadership role and you know, that's an area that maybe for other physicians, some of our physician listeners or laboratory professionals, that's a role

that many aren't used to thinking about. So I'm kind of curious about how, how do you and your team work together to, to really affect patient care? - Yeah, that's a great question. I mean, you pathology, you know, you learn to be a leader because you have to lead within the laboratory, right?

And you, you have to start, you know, organizing people to around common goals within the lab to, you know, raise the quality, develop the new, as you through career in pathology in medicine, you understand that there's roles in that medical leadership of the clinical laboratory. It gets to the exact question you want.

You, you, you raise is, you know, how do you work with the team then to further the, the impact of laboratory practice into the clinical practice and how do you, you know, stay abreast and work with people that stay abreast of the most recent developments? I am, you know, very brand new to Mayo Clinic of, obviously I'm new of Mayo Clinic for my entire career, but I, I am new here figuring out the, you know, how to operate in this environment.

But, you know, one thing that's is immediate clear is that there are, you know, leaders in the field in pretty much every specialty in lab medicine and pathology. And, you know, these are the places where you can have a large impact by pushing the boundaries, doing innovative tests, working with a very sophisticated medical practice. And it's that kind of marriage of, you know, being on the cutting edge of technology, AI automation to really improve patient care.

And that's, you know, what the, the focus of, of a place like Mayo really sort of lends itself to that singular mission. And it's been nothing but a pleasure to be here so far. - You know, if I can put a couple of things together, I think, you know, in the earlier answer you were talking about the important role of, of curiosity and always remaining curious.

And then now in this answer on how you're working to affect patient care, you're talking about, you know, leadership building bridges, pushing the boundaries, advancing innovative practice. I'm kind of curious for, you know, what are your thoughts about, for our maybe student listeners or kind of young faculty that are curious and, and want to cultivate those skills of, of leadership

and working in this direction, what advice do you have for them? - Wow, that's a great question. I, I would think, as you say, you know, be curious, having an open mind, understand, especially nowadays that you can't do everything yourself. Working in teams becomes very fulfilling. You can always do more in a, in with, with a team around you than, than than by yourself. And that, you know, particularly those interested in pathology and lab medicine as a career is that it's so diverse.

I mean, pathology and lab medicine is all of medicine, right? We the consultants to other physicians and, you know, you can do almost anything in laboratory medicine for, in pathology from, you know, being a forensic pathologist to doing HLA testing to hematopathology, to, you know, focusing on GI pathology to clinical microbiology. I mean, it is all of that. And you can find a niche for yourself and develop that, that interest.

So, you know, going into pathology and lab, making that decision seems like, oh, I've decided my specialty, but still the entire world of medicine in a way is still open to you. And you have to, you know, decide if I'm gonna specialize and what that's gonna be, what what do I like to do? And so it's a really, it's a really nice place to be when you, you understand that, you know, possibilities remain open to you no matter where you go in your career.

I mean leadership lab, you know, and that, that kind of role is also open to you. So yeah, - Maybe, and also, I wonder if I can flip it around to the other side and think about advice for our clinicians that are listening to this podcast. And maybe there are clinicians, hopefully if they're listen to this podcast that they are aware of, of the role in thinking about the role of, of laboratory medicine, but they might share it with their colleagues.

And so for, for the listener who maybe hasn't thought about the role of the laboratory in their practice, what would be your advice for how to kind of approach building that bridge maybe more explicitly in their practice? I think maybe some clinician listeners may not understand where to start. - Yeah. I would say, you know, please reach out, contact us. We, we don't bite.

We, we love, in fact, part of our, you know, pathologists oftentimes are introverted and, you know, we need to be brought up, but we are always happy to, to consult and, you know, lend our expertise. You know, we become part integral parts of the care team. I think that's one area that we, as a field, our next big push is to become a little more integrated in front and center in in the care team.

And, you know, I, one of the, my hobbies and you know, is sort of, you know, in lymphoma pathology and, you know, I got involved in some clinical, you know, research groups and research foundations that, you know, deal with certain kinds of lymphoma. It's a patient advocacy, get to patients is another avenue that is really satisfying because patients are also curious about laboratory testing and their particular results.

And so that's another, you know, way that pathologists may not have not traditionally been involved in part of the care team. But that's certainly was a very fulfilling exercise for me. Other pathologists actually are involved with that. Transfusion medicine people deal with, you know, more directly with patients and things like that. So I think, you know, as, as, as we as a field develop, you know, our next frontier is really to get a little more front and center in the care teams.

- Wow. So that really leads into my final question. I was wondering if we could kind of close out, you know, you're, you're obviously in a very key leadership position and you've already kind of tipped your hand a little bit for

where do you see the future of the laboratory? Where's, where's the laboratory headed? If you could elaborate a little bit for us? - Yeah, that's a a great question. Yeah. I, I maybe alluded to a little bit that was a good segue, I guess. But I think there's other as, as we move forward in information. 'cause I think at the end of the day, yes, we're doing all these testing, our laboratories are generating, like we said, you know, a large chunk of the information being used to treat patients.

But at the end of the day, it's information, right? And so how do we leverage that information in new ways to add to, you know, the, the diagnostic decisions we're even talking, you know, as, as you may know, you know, Mayo Clinic has been digitizing its entire glass archive for over, you know, millions of slides, which is great. But at the end of the day, okay, so now we've just put the information there.

Now what we need to do is figure out, you know, how to unlock that information and get new data from the archival, you know, image data that we, we have. And that's, that's certainly one of the new frontiers, you know, leveraging, you know, ai, machine learning, digital pathology on one side helping to automate things. And then on the other side is just as I just mentioned, you know, getting the people and the, the lab professionals, you know, more front and center in the care teams with

that new information that we bring. Right. - Right. And I almost as I hear you listen to your answer there, it makes me think about meaning making is kind of the, the phrase that kind of pops up in my mind of, you know, we have this information, but what does this mean? And I think, you know, I I really, that that mission you're talking about getting the pathologist more integrated with the care team really resonates with me.

What do you think is, might be our biggest challenge with that step forward into more of those that clinic domain? - Yeah. Well I think it's, you know, part of it is, you know, workforce and kind of like keeping people interested in going into the field.

Yeah. Is you and I both know, it's getting harder and harder to find people that get into the field because, you know, there's so many things people been doing and how do we make sure that people understand there's this super interesting career path that is contributing to health of the population and, and you know, how do we keep those people interested?

And then how do we continue to develop the skillsets that we need in terms of, you know, information management and computational pathology, which is kind of the new buzzword, right? And, and build those skill sets into the training program so that we can continue to grow as a specialty. I think those are things that we will be trying to figure out over the next coming, you know, decade.

- Wow. That's a great way to close out that makes my medical educator heart go pitter-patter to hear you bring in the close of where is the laboratory going to, talking about the people in our community of practice and, and how we're training 'em. Thanks so much for joining us, Dr. Hsi. - Oh, thank you. It's been a pleasure. Happy Lab week - And thank you to the audience for joining us. We invite you to share your thoughts and suggestions by email.

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