October 2005 Mentor of the Month Interview: James Westgard
Biography
  1. What is your job title and affiliation?
  2. Briefly tell us about your educational and career background
  3. What are your Board certifications?
  4. With which professional societies/organizations (e.g. AACC) are you involved?
  5. Just for fun, tell us a few interesting facts about yourself.
Career
  1. What area(s) do you specialize in?
  2. What initiated your interest in this (these) area(s) and how did you eventually choose this (these) area(s) for your career?
  3. What are your clinical and research interests?
  4. What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine?
  5. Are there specific aspects of practicing laboratory medicine that you find unappealing?
  6. What were some of the most rewarding and/or challenging moments of your career?
  7. What excites you about practicing laboratory medicine everyday?
  8. What are your predictions for advances in laboratory medicine and/or your area over the next ten years?
  9. What do you see as the challenges facing young scientists in laboratory medicine?
  10. What specific goals would you recommend that young scientists in your discipline set for themselves? Any suggestions on how to achieve them?
  11. Describe how you have been able to give back or contribute to the organizations and the profession in general through your involvement in AACC.
  12. How did you get started in these organizations and what advice do you have for young people wanting to get involved?
  13. Do you have any other specific comments or advice that you like to provide to the members of SYCL?
Biography
  1. What is your job title and affiliation?
    I’m a Professor in the Department of Pathology and Laboratory Medicine at the University of Wisconsin Medical School. Serve also as Faculty Director for Quality Management Services at the Clinical Laboratories at UW Hospital and Clinics. Also am President of Westgard QC, Inc., a small business that deals with tools, technology, and training for laboratory quality management.
  2. Briefly tell us about your educational and career background
    Undergraduate major in Chemistry from Concordia College in Moorhead, MN. Masters and PhD degrees in analytical chemistry from the University of Wisconsin-Madison. Otherwise trained on the job in the clinical laboratory by many smart and talented Medical Technologists. Have spent my whole career at UW, which is surely unusual today. Started as a clinical chemist, was Director of Clinical Chemistry for about ten years, was Associate Director of Laboratories for Administration for a couple years, then Associate Director for Quality Control, which eventually turned into Quality Management. Have always taught in the Clinical Laboratory Science program, where we have also developed a Graduate Certificate in Laboratory Quality Management that is offered by the Internet. Some 10 years ago, I started Westgard QC as a small business to support software development and training activities outside the University setting.
  3. What are your Board certifications?
    I entered the field of clinical chemistry at a time when there was no need for post-doctoral training or certification and have always been in an academic position where other qualifications and accomplishments are recognized.
  4. With which professional societies/organizations (e.g. AACC) are you involved?
    Mainly AACC, ASCLS, and CLSI. I am also a member of ACLPS and ASQ. I was the first chairholder of the CLSI Evaluation Protocols Area Committee and have periodically served on other committees and working groups. Right now am chairing the working group that is revising C24A3, which is their document on statistical quality control.
  5. Just for fun, tell us a few interesting facts about yourself:
    • Family
      Married with two children and now have four grandchildren between ages 1 and 5. My wife of 40 years, Joan, is retired from being Budget Director for the University of Wisconsin System and is now an antique dealer. We spend a lot of time traveling and visiting our grandchildren. Our daughter Kristin is a lawyer who lives nearby in Milwaukee. Our son Sten is the person behind the Westgard Website and all of the publications from Westgard QC. He lives in Connecticut, but we are in close contact via e-mail and telephone almost everyday.
    • Favorite activities/hobbies
      Favorite activities are reading and listening to jazz. Nice to be able do both at once, but there’s still never enough time. I collect antique maps, particularly of “myths and mistakes”, as well as maps of the Scandinavian countries, which represent some of the most famous mapmakers from the 1600s (e.g., Ortelius, Mercator, Blaeu, and Jansonnius) [ www.westgard.com/essay2.htm ]. Am the “furniture guy” for my wife’s antique business, which means I do the repairing and refinishing. We have a lot of fun with collecting antiques and all the associated activities.
    • Favorite places you have traveled
      The fjords of Norway and the Great Wall of China rank the highest on a long list of travels. Most recently we visited Slovakia and enjoyed hiking in the High Tatras, and also visited the Czeck Republic and found Prague to be a wonderful city. We are planning a cruise up the Norwegian coast to the land of the midnight sun next summer. I expect that might top everything!
    • Favorite book/movie
      Tough call between mystery thrillers and real-life politics – and sometimes there’s not much difference between the two. I certainly found the exposes on Enron as intriguing as any works of fiction [ www.westgard.com/essay58.htm ]. If I were to pick one book, I would say that Ron Suskind’s book about Paul O’Neill (The Price of Loyalty) had the most impact on me [ www.westgard.com/pdf/NBTchapter25.pdf ]. I now read most of the political books about our current government and being from Madison, WI, you can correctly predict that I’m one of those liberals. After many years of not paying much attention to politics, I’m getting more interested. But it takes a lot of time to figure out what’s really going on today. You need to read, not watch television. That means finding a good newspaper as well as some good news magazines, and also reading books about current events[ www.westgard.com/essay71.htm ].
    • Most fun/adventurous thing you’ve ever done
      Most fun is definitely having grandchildren! Kris and Sten each have one son and one daughter, so we have a completed matched set. Most adventurous thing was moving to Sweden when our Kris and Sten were 7 and 4 years old. We had only traveled out of the country one time before. Had a Swedish friend who helped us get set up with the essentials – apartment, post office, bank account, and systembolaget (the state operated liquor store). Sweden was a very expensive place to live, so expensive that we went to eat in restaurants 2 times in a whole year. But we met many wonderful Swedes and continued to work with them for many years. We also met people from Finland, Norway, and Denmark during this time and we continue to visit the Scandinavian countries to renew these acquaintances.
Career
  1. What area(s) do you specialize in?
    I started out in clinical chemistry and became interested in laboratory quality management. That’s probably not an area that one can specialize in today, but it was a natural fit because of my training in analytical chemistry and the skills and techniques that were needed as automation came into the laboratory.
  2. What initiated your interest in this (these) area(s) and how did you eventually choose this (these) area(s) for your career?
    Mainly came out of need to solve practical problems in the laboratory, starting with the evaluation of new methods which then led into quality control, which then expanded to quality management on a broader scale. I was fortunate to have the opportunity for a sabbatical year just when I was finishing the initial work on method evaluation statistics and protocols. The year at Uppsala University was the start of my interest and work on statistical QC. That time of study undoubtedly had the most influence on my direction and career in clinical chemistry, as well as opened many doors internationally. I consider Uppsala to be a second home and always have a warm feeling when I have a chance to visit again. I later did a 2nd sabbatical, spending part of the year at Hartford Hospital and the other part at Odense University Hospital in Denmark. A lot of the QC planning and selection methodology came out of that year of study.
  3. What are your clinical and research interests?
    Mainly work on analytical quality management, which often involves working out the appropriate statistical data analysis techniques and coming up with practical tools for everyday applications. There isn’t any real difference between my clinical and research interests as I’m generally trying to solve problems that originate in laboratory practice and service.
  4. What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine?
    I think the introduction of the “total error” model [www.westgard.com/essay15.htm ] and the subsequent expansion into analytical and clinical quality-planning models have been the most important contributions because they provide a framework for quantitative quality management. Those models show the relationship between the quality required for a test, the precision and accuracy characteristics of the measurement procedure, and the rejection characteristics of the QC procedure. [www.westgard.com/lesson7.htm ] Many people will think of the multi-rule QC procedure that became known as “Westgard Rules,” but I consider that to be an example of the general concepts and principles that evolved from the studies on the performance characteristics of measurement and control procedures [www.westgard.com/multirule.htm ]. If quality QC is doing the “right QC right,” then the quality-planning models are most important because they provide the framework for selecting the right QC procedures to assure the right quality is being achieved in the laboratory. To help people apply these quality-planning models, I have also spent considerable time developing computer tools to make it easy for others to do this in their own laboratories [www.westgard.com/essay80.htm ].
  5. Are there specific aspects of practicing laboratory medicine that you find unappealing?
    I think about this in terms of service, research, and teaching. All three are important and rewarding, and I’ve had a good balance over my career. However, it is difficult to do all three at the same time. I tend to have a primary focus in one area for a couple of years, then refocus in another area, and so on. Teaching Medical Technology students has been the most constant over the years and I consider teaching to be the most important activity for helping other people in this field [www.westgard.com/essay52.htm ].
  6. What were some of the most rewarding and/or challenging moments of your career?
    At the 1976 Aspen Conference when I first presented the concept of total error and its application in method evaluation studies, several of the leading pathologists voiced their heated objections to the ideas. It was a harsh reception for a young clinical chemist, and it made me aware of the need to market ideas through education and training. You can teach new dogs new tricks, and I focused on teaching new Medical Technology students new ways to handle method evaluation studies. Later on, when we published these teaching materials in the American Journal of Medical Technology, the editor wrote a forward describing the approach as “a gift, an innovation that makes manageable what used to be so complex.” That is the kind of reward I value most and I do get a lot of positive feedback from people in laboratories who I meet for the first time at a scientific meeting or workshop, who have read and studied some of my writings, and have implemented some of the ideas and approaches.
  7. What excites you about practicing laboratory medicine everyday?
    Not sure “excite” is quite the right word, but I’m driven more each day by the increasing issues with quality in healthcare, the increasing importance of laboratory testing on the national scene, and the increasing needs for education and training if laboratory testing is to fulfill its critical role in healthcare today. Coupled with the shortage of well-trained laboratory scientists and the ongoing debacles of CLIA and the inspection/accreditation approach to quality, there is much that still needs to be done and few people who understand what to do.
  8. What are your predictions for advances in laboratory medicine and/or your area over the next ten years?
    I think we will start to see automatic QC processes that will complement today’s automatic measurement processes. Today we have 5th generation automated measurements with 1st or 2nd generation QC procedures. QC needs to catch up, which means the QC procedures have to become completely automated. New instruments should be smart enough to only report test results that meet the quality requirements defined by the laboratory, i.e., they should guarantee the quality of test results.
  9. What do you see as the challenges facing young scientists in laboratory medicine?
    Keeping up in any knowledge based field will become more and more difficult. While there will be scientific and technical challenges, I think balancing professional and family needs and responsibilities will be equally important. Ultimately, people have to figure out what is meaningful and what is frustrating and achieve a balance that provides personal satisfaction. That is tough to do early in one’s career because there are external yardsticks that may be more important than the internal ones. But, somehow we all need to find the time to make the right choices, rather than just have things happen to us.
  10. What specific goals would you recommend that young scientists in your discipline set for themselves? Any suggestions on how to achieve them?
    I think the specific goals will depend on your own interests, and no one else can really identify those for you. However, it should be helpful to talk with others as part of the process of identifying those goals that are important in your work and career. Goals are important, but I also think you need to maintain the flexibility to take advantage of the available opportunities and, likewise, to make contributions and gain fulfillment in whatever you are doing. The only specific recommendation I would make is that if you choose an academic career, be sure to take advantage of any sabbaticals that come along. That will give you time to periodically adjust and refocus your goals and the direction of your career. If you choose a business or industry career, take advantage of any opportunity to live in another country and experience another culture.
  11. Describe how you have been able to give back or contribute to the organizations and the profession in general through your involvement in AACC.
    My main way of contributing professionally is through education and training. Early in my career I presented a lot of papers and workshops at professional meeting. Now it is more in the form of independent seminars and workshops, which I particularly enjoy because participants choose to attend and are interested in learning something new [ www.westgard.com/essay45.htm ]. I have spent a lot of time developing educational materials, such as the books that are available through the AACC bookstore and the training materials that are provided on the westgard.com website. In fact, most of the materials in the books are available as “lessons” on the westgard.com website. I can’t take credit for the Westgard website – that idea came from my son, Sten, and he is the person who does all the work. The website gets several thousand visitors per week and our e-mail database is over ten thousand people. When I travel abroad, I often meet people who know everything that I do because of the website.
  12. How did you get started in these organizations and what advice do you have for young people wanting to get involved?
    I think CLSI is maybe more open to individual initiatives than some other organizations, and you can start by being an observer on committees that are of interest to you, then work your way into being an advisor and/or member of a committee. In AACC, you need to get active in your local section because it serves as a doorway to national activities. That will work fine if your local section is indeed local, but may be difficult in locations where the local section covers a large geographic area. In my case, the local AACC section is Chicago, and I have found that a distance of 3 hours limits my participation.
  13. Do you have any other specific comments or advice that you like to provide to the members of SYCL?
    It’s very important to like what you do and to gain satisfaction from your work. While it’s nice if others recognize the value of what you do, it is most important that you yourself find value and satisfaction in what you do. There are a lot of external motivators and marks of success, but they don’t necessarily make you happy in your work and in your life. Likewise, there will be politics in any job and you will have to find the balance between your own values and the values expected by others. It’s important to develop confidence in yourself and be secure in what you do in order to weather the ups and downs of your job and your life. Luckily, I’m a Norwegian with a stubborn gene, which has served me well and contributed to my survival, but I will admit that my family may have a different perspective and opinion about this characteristic.
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