September 2006 Mentor of the Month Q&A Session: D. Robert Dufour
Welcome to SYCL's Mentor of the Month.  Questions and Answers will be displayed below...

What is the laboratory medical director's role in determining which esoteric tests (ie, molecular tests) should be performed on a hospital inpatient?

D. Robert Dufour, M.D.
I think this is a matter for negotiation between the laboratory and the institution and its medical staff.  In most situations in the US, reimbursement for hospital care is based on diagnosis, so unnecessary testing adds to non-reimbursable costs.  Review of laboratory test requests for high cost tests can be a way to reduce expenditures.  Also, many tests, particularly those in the endocrine system, are affected by acute illness, and can produce misleading results. 

In my institution, we have had a longstanding policy of reviewing all tests referred to a commercial laboratory.  We ultimately end up not sending about 20-25%.  Some are cancelled because they are not collected properly, and some because they are duplicates (we have found duplicate requests more common with send-out tests, because physicians sometimes reorder tests because they have not seen the results).  Often, we suggest alternative tests to answer the questions being asked by the physician.

To be able to effectively serve in this role requires a good understanding of the uses of tests, the ability to interact well with others, and the ability to present one's position clearly and effectively.

Professor Robert Dufour, In quality of an AACC Member and Fellow NACBMember, I ask you to tell me what are the requirements to enter apost-doctoral training program in clinical chemistry. With many thanks, Aurelian Udristioiu, MD, Director of Laboratories, County Hospital
Tg-Jiu, Romania

D. Robert Dufour, M.D.
This answer may differ in other parts of the world, but in the United States there are two tracks available to a physician.  The first is through training in pathology; programs have training in anatomic and clinical pathology or in just clinical pathology.  Such training is available in a large number of institutions, but does not specifically provide training in clinical chemistry.  Combined anatomic and clinical pathology training requires four years, while clinical pathology alone requires three years.  Additional training is available in a smaller number (10-20) institutions in chemical pathology, training that usually takes an additional 1-2 years.  These training programs would enable a person to qualify for Board Certification through the American Board of Pathology.

An alternative approach is available for both MD and PhD individuals.  There are about 15 post-doctoral training programs  in Clinical Chemistry (lasting 1-2 years), which can lead to eligigibllity to take certification examinations by the American Board of Clinical Chemistry.

Dr. Dufour, What are the requirements for maintaining stability of the serum specimen after blood is collected for Vitamin B12 analysis?
Tampa, Florida

D. Robert Dufour, M.D.
Generally speaking, vitamin B12 is a relatively stable analyte; routine handling with reasonably rapid separation of serum from cells and refrigerator storage should be adequate for samples analyzed on a regular (say daily) basis. For longer storage (several days), freezing is preferable. As with any other test, requirements may be different for kits by different manufacturers, so always check the package inserts for the kit you are using.

At this point in your career, where do you see yourself in 1, 3, and 5 or even 10 years from now?
Seattle, WA

D. Robert Dufour, M.D.
As I think I made clear in my biographical sketch, I have retired from full time work; I currently work 2 days per week, as well as traveling to present at and attend conferences and for speaking engagements.  I would see that I would likely continue in this fashion for tne next 3-5 years, eventually reducing the time I am in active practice.

I think it is important, however, for each person to set their own career goals.  I know others of my age who are still active in practice and/or research.  I have many other areas in my life that I wanted time to explore, such as learning more about music, having time to travel with my wife, and time to write and read.  For me, the decision to retire from full time work was made easier by having a defined benefit pension and good health benefits.  For others, the desire to keep working is also accompanied by the need for steady income.

Dr. Dufour-- I was delighted to read that someone else's favorite movie is The Princess Bride (inconceivable!)."Quit rhyming, I mean it. -- Anybody want a peanut?" But I digress... My question for you is this: I have watched you give several talks, and have always been impressed with your teaching skills. What do you think are key assets to being an effective teacher?
Rochester, MN

D. Robert Dufour, M.D.
I think the two most important aspects to being a successful teacher are knowledge of your audience and the ability to present ideas in a clear, understandable fashion.

First, it is critical to understand the level of knowledge of your audience.  This avoids the common error of starting at too high a level of presentation.  By being aware of the knowledge base of your audience, it is possible to construct a presentation at the appropriate level.

Presenting in a clear, understandable manner means more than starting at the right knowledge level.  It includes the ability to present the explanations for factual information, which promotes understanding rather than simply memorization.  It involves perparing audiovisual material that reinforces what is presented, and is reafily legible by the audience.  It involves keeping eye contact with the audience to assure that your message is getting across, and adjusting your presentation accordingly if it is not.

Above all, I think you need to have a love of teaching.  This includes soliciting feedback from your audicence and being willing to change based on that feedback to improve your abilities as a teacher.

I am a Clinical Chemist (Ph.D).I had encountered a case of hypoproteinemia and hypoalbuminemia in an admitted patient on routine biochemical analysis of blood after surgery.However after two days the serum levels of albumin and Protein was found to be withinf the normal range.On investigating the history of the patient it was found that the patient had pseudocyst of the pancreas.Can you please explain the relationship between Hypoproteinemia AND Hypoalbuminemia AND Pseudocyst of the pancreas?
Mumbai, INDIA

D. Robert Dufour, M.D.
In this case, I believe that the cause of these changes was the administration of fluid during the surgery. I have, on many occasions, seen similar changes occur transiently during surgery. As an operation is ongoing, fluid is lost, and often replaced with a combination of packed red blood cells and water-based fluids that may be hypotonic with respect to plasma. The result is a dilution of normal plasma components. The body can readily handle the extra fluid and, over the course of one or two days, return blood chemistries to normal. I don't think there is anything specific to the type of surgery, other than the length and difficulty of the procedure (in this case, repair of a pancreatic pseudocyst), only the relationship of these paramaters to how much blood and other fluids must be administered to the patient.

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