November 2011 Mentor of the Month: Andrea Rita Horvath
Biography & Career
  1. With which professional societies/organizations (e.g. AACC) are you involved?
    Hungarian Society of Laboratory Medicine Member, 1984 – to date
    President Elect, 2002 – 2004
    President, 2005 – 2008
    Past President, 2009 – 2011
    Association of Clinical Pathologists, UK (member), 1994 – to date
    Association for Clinical Biochemistry, UK (member), 1994 – to date
    Royal College of Pathologists, UK
    Member (MRCPath by examination), 1994 – 2000
    Fellow (FRCPath)
    2001 – to date
    Committee on Evidence-based Laboratory Medicine, Education and Management
    Division of the International Federation of Clinical Chemistry (IFCC)

    Associated Member, 1999 – 2000
    Member, 2000 – 2002
    Chair of Committee, 2003 – 2008
    Cochrane Collaboration, Screening and Diagnostic Test Methods Group (member), 2003 – to date
    GRADE (Grading the Evidence) Working Group (member), 2004 – to date
    American Association of Clinical Chemistry (AACC) (member), 2007 – to date
    European Federation of Clinical Chemistry and Laboratory Medicine formerly European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4)
    Secretary General of EC4, 2005 – 2007
    EFCC President elect, July 2007 – June 2009
    EFCC President, July 2009 – June 2011
    EFCC Past president, July 2011 – June 2013
    Australasian Association of Clinical Biochemists (member), 2010 – to date
    AACB 'Quality Initiatives in Pathology' – Harmonisation of Laboratory Testing: Critical Values (Project leader), 2011 – to date
    Fellow of the Royal College of Pathologists of Australasia (FRCPA), 11/02/2011 – to date
  2. How did you get started in these organizations and what advice do you have for young people wanting to get involved?
    I voluntarily joined all these national and international organizations; sometimes at the advice of my bosses, sometimes by invitation and I started contributing to the works of existing teams. When you are young you get interested in so many things as you realize how little you know and exploring the unknown is a challenge, as well as, an adventure with all the learning, excitement and professional satisfaction that come with it. The above list probably well demonstrates that I always started from the bottom of the ladder and by contributing more and more voluntarily your journey up on the ladder is almost automatic. Then new people and new projects find you easily. Once you reach that state, an important thing is to learn how to select from those opportunities and decide which areas you should focus your attention and energy on. This is probably the hardest as my professional curiosity is always bigger than I physically can manage in the 24hrs of the day. So, what advice can I give to young scientists wanting to get involved in professional organizations?
    • Identify areas that are professionally interesting or exciting to you and just throw yourself into it and contribute voluntarily.
    • Many national and international organizations are eager to identify professionals who are willing to contribute to their works, so make yourself visible.
    • When you contribute, never be shy of asking challenging questions, but also make your own effort of finding some answers by digging deep, reading a lot, analyzing the problem in depth, and thinking of workable solutions. Identifying problems is relatively easy, asking good questions that lead you to finding the right answers is much harder, but putting those solutions in practice is the real hard job. You have to make sure you follow all steps through.
    • Identify what type of person you are and get involved in areas where you have your strengths. Some people are good at all these steps. Others are very good at strategic thinking and identifying what needs to be done, but not so good at implementing those changes and vice versa. You need to know where you fit best into a team and you also need to decide how much time you feel you can dedicate to the actual project.
    • Be always clear about what you can deliver but then you must deliver what you promised.
  3. What area(s) do you specialize in and what initiated your interest in this (these) area(s)?
    I am a medically qualified laboratory medicine specialist. My specialist interest has changed throughout my career. Initially I was heavily involved in basic research, investigating the link between platelet cytoskeleton and signaling pathways, and my clinical expertise was mainly in thrombosis and haemostasis. This was mostly driven by my outstanding boss and mentor, Professor Laszlo Muszbek, who gave me these scientific projects in the beginning of my career in laboratory medicine. These were the most exciting times of my career as basic research is about exploration, discoveries, finding new things nobody found before. Furthermore, it taught me how to ask new scientific questions and how to design and carry out well controlled, reproducible and good experiments that give scientifically valid answers. Experimental research helped me a lot in my future career as a clinical laboratory professional in many ways: it taught me scientific thinking, gave me a lot of practical knowledge of basic laboratory techniques, it helped analyzing data critically and how to draw careful conclusions which then might identify further gaps in our knowledge and generate new hypotheses and lead to designing new experiments to prove those theories.
    Then, later in my career, my interest turned to evidence-based laboratory medicine (EBLM). This was initiated by a visionary project that Danielle Freedman started at the Association of Clinical Biochemists in the UK in the mid-nineteen eighties, and that I joined while I was working in Oxford. The project investigated the evidence behind the laboratory monitoring of thyroxine replacement therapy in primary hypothyroidism and well preceded the science in those days about evidence-based diagnostics and monitoring. In those days in Oxford, when David Sackett was leading the Evidence-Based Centre at the University, it was almost contagious and unavoidable to be “infected” with evidence-based medicine (EBM). This subsequently led to my involvement in the work of IFCC’s EBLM Committee, which I later chaired for 6 years. This also led to a major national EBM grant and educational project that I ran in Hungary for over 10 years with the government for various clinical disciplines.
  4. What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine?
    This is a difficult question to answer as I do not think I have made any important contribution. I have been doing my job only and do what is required in any areas I am getting involved in. Of course I am proud of a few achievements both in my scientific and professional work which eventually led to some changes in national policy as well.

    Scientifically:
    • Discovering the c-src oncogene-mediated tyrosine phosphorylation pathway of platelet adhesion molecules which subsequently led to further understanding of the role of integrins and receptor tyrosine kinase signalling functions that are important for the initiation, progression and metastasis of solid tumours and in other physiologic cellular functions.
    Professionally:
    • Setting up the Hungarian national accreditation scheme for medical laboratories in all disciplines of pathology.
    • Establishing the Hungarian LabTests Online patient information portal, in collaboration with AACC, this has the second highest penetration rate amongst the online population in an international comparison.
    • Development of evidence-based methods for diagnostic and monitoring test evaluations; and contribution to the development of evidence-based guidelines and laboratory medicine related recommendations in many medical fields.
    • Strengthening the position and role of the European Federation of Clinical Chemistry and Laboratory Medicine (EFCC) as a leader of the profession in Europe.
    Politically:
    • Establishing a sustainable EBM Network and evidence-based health policy, guideline development and clinical audit framework in Hungary.
  5. What were some of the most rewarding and/or challenging moments of your career?
    Most rewarding:
      • Working for my PhD and publishing my best research papers (Oncogene, 1990, 5: 1349-1357; EMBO J, 1992, 11: 855-861.)
      • Teaching medical students in clinical chemistry and educating health professionals in quality management and EBM/EBLM worldwide
      • Establishing a brand new university department of laboratory medicine in Hungary and having the opportunity to build and work with a wonderful and dedicated team.
      • Running the Hungarian EBM network for 10 years
      • Chairing the IFCC EBLM committee
      • Becoming elected president of the Hungarian National Society and subsequently president of EFCC
    Most challenging:
      • Building and managing a university department under constant political and financial pressure and working under non-visionary leadership
      • Encouraging and engaging people in voluntary work for the profession
      • Convincing politicians that EBM and EBLM are important
      • Coping with cultural and ethical differences and with differing working morale
      • Making EFCC a more mature organization and running EFCC while also moving jobs, home, country, and continents with my family.
      • Making compromises without giving up your basic and moral principles and vision
  6. How would you recommend achieving an optimal work/life balance?
    Maybe I am not the best to make such recommendations as my family keeps reminding me, rightly, that I should achieve a better balance. I consider myself lucky as I have a very tolerant and wonderful partner who has been encouraging and supporting my career constantly. So my number one recommendation is that if you are career and result-oriented, find a very supportive partner and let him/her take control of your family life and do what he/she wants. Then you can be easily distracted from work and do other things that you always wanted and also liked to do.
    My number two recommendation is to be focused and efficient at work so that you can go home without papers in your handbag to read at night or over the weekends. Always allow some time for enjoying your hobbies and family life as it also improves your work performance, and vice versa.
    My number three recommendation is (or rather was until very recently): not to have email connections to work while you are at home or on holidays. If you cannot avoid having access, at least avoid opening your work email boxes when you are with friends and family!
    Lastly, if you are in charge, create a working environment and culture, with a trusted team and a well-established quality management system around yourself in the lab where your colleagues know how to solve problems and maintain high standards of service even when you are away. A good boss is not the one without whom the department immediately falls apart but without who staff is able to run all functions of the lab smoothly and professionally and at the same level of quality.
  7. What are your predictions for advances in laboratory medicine and/or your area over the next ten years?
    More integrated multidisciplinary diagnostics, including genomics and proteomics and even imaging. More focus on screening and prevention, and personalized medicine which will require pharmacogenomic testing and will increase the demand for the development of companion diagnostics.
    My area for the next 10 years or so will be developing evidence-based frameworks and tools for the evaluation of the clinical effectiveness and impact of new biomarkers and for designing better research studies for proving the clinical utility of new diagnostic and monitoring tests.
  8. What do you see as the challenges facing young scientists in laboratory medicine?
    • To remain established clinical partners and to maintain a consultative service to clinicians
    • To be able to run a multidisciplinary laboratory service under more and more financial pressure
    • To keep laboratory testing within the profession
    • To cope with the information and volume overload in medical laboratory practice while maintaining a high quality service
  9. What specific goals would you recommend that young scientists in your discipline set for themselves? Any suggestions on how to achieve them?
    What goals?
    • Always have high ambitions but realistic aims you can achieve
    • Keep improving and maintaining your professional knowledge and skills in laboratory medicine (I call this “horizontal knowledge” needed for your everyday work) – i.e. read a lot!
    • Try to become an expert at least in one particular field (I call this “vertical knowledge” needed for your special interest area) – i.e. read a lot but also do your own laboratory or clinical research in that field!
    • Be customer focused and become a trusted partner of your clinicians
    How to achieve them?
    • Set goals that interest you but will also serve the interest of people around you (unless your prefer lonely journeys)
    • Build teams around yourself who will voluntarily follow and support you if your goals are good
    • Work hard and be focused and efficient
    • Read a lot and publish your findings
    • Share knowledge and work and success (Do not be selfish; it is not all about you, it is your team and family with whom you achieved them!)
    • Move out of the lab and talk and carry out projects with clinicians as much as possible.
  10. Do you have any other specific comments or advice that you like to provide to the members of SYCL?
    • Always enjoy what you do and only do what you truly enjoy.
    • Stay always young at heart and remain as positive, open and enthusiastic as you were when you started your career
    • Maintain an active interest in the profession until you physically and mentally can (but listen to signs and feedback)
  11. How did you discover lab medicine/science?
    In Hungary medical students have the opportunity to join various university departments and get engaged in scientific work that can also lead to a thesis or publications. So I joined Professor Laszlo Muszbek’s newly established Clinical Chemistry Department when I was a 2nd year medical student and started a project on tissue transglutaminases with Prof. Laszlo Fesus, an excellent young scientist and a charismatic tutor. At the time this department had close collaborations in the US with Professor Albert Szent-Gyorgyi (the Nobel prize winner for discovering vitamin C) and particularly Professor Kalman Laki (who, together with Professor Laszlo Lorand discovered the plasma transglutaminase, i.e. factor XIII of blood coagulation). We developed an in-house kinetic assay for measuring transglutaminase activity and investigated the regulation of the enzyme. In addition, I wanted to learn the basic laboratory techniques and earn some money to support myself, so that I was not fully dependent on my parents’ budget. Thus I started working as a technician at night shifts in the routine laboratory until the end of my student years. We published two papers while I was a medical student and subsequently, my mentors asked me if I had an interest in joining the department as a postgraduate trainee. Initially I was a little hesitant, as I was interested in becoming either a pediatrician or a neurologist, but very soon I decided to go for this position, and then never looked back…
  12. How do you handle stress/pressure?
    It varies on the amount and duration of stress, where the pressure is coming from and what its nature is. My slogan is, “Don’t crack under pressure!” A ‘healthy’ level of stress and pressure usually makes me perform and focus much better. Offloading frustration to family and friends and sharing problems with colleagues help a lot in relieving stress.
    If pressure or stress is related to too much work and pushing deadlines but I am genuinely interested in or committed to that work, I just sit down and prioritize and make a “to do” list and schedule them. When there is a task, let it be professional or domestic (such as refurbishing your house or creating your own garden), I first plan it (usually this takes the longest) but then throw myself into it and almost obsessively push myself to my own limits and work hard and long hours (for even weeks or months if necessary), until I achieve what I have set as a goal. My sister is very much the same, so we clearly learned this attitude from our parents.
    If it is unrealistic that I can do a job by the deadline, I always let the other parties know and we agree on rescheduling the task, when possible. This relives the pressure or reduces it to a manageable level. If, however, pressure comes from external sources and relates to jobs that you do not like or wish doing, I simply but politely say no. If I cannot say “no” as it is a work obligation then I work out how best we can share the task with my team. If I cannot share this type of work and I must do it, then I leave it to the last minute and then deliver it.
    I rarely give up anything and first I always try to understand the motives or reasoning of the other side where the pressure comes from. If I can associate myself with their rationale or reasoning I try to help and contribute, but if I disagree or there is extreme pressure or stress or frustration or too much politics which I realize are beyond my control and I cannot do much about, then I simply give up. There are times when it is just not worth pursuing unachievable tasks or getting into more trouble and generating more stress for you. I often notice that less push, a bit more patience and time helps in cases like this and in the end (sometimes only years later though, but) you get what you wanted.
  13. What is the most important leadership skill to have?
    • Be visionary, have strategy and goals and couple these with action plans
    • Lead by example
    • Listen to staff and communicate regularly with your team
    • Identify strengths and weaknesses of staff and give them tasks which they can perform best
    • Empower your staff and nurture ambitions
    • Set high standards but provide mentoring/coaching and recognize achievements
    • Team building skills and capacities
    • Be principled, systematic, consistent and fair
  14. What is an average day like in your life?
    I am not a morning person, so my usual day starts at 7 am with a coffee at home and the second when I arrive in work at around 9:30. I start with looking at the (numerous) emails and answer about 80% of them within the same day. Then I often go to the lab and talk with staff to see how the daily routine is running and whether there are any issues I need to know about. I usually have a very light lunch in my office while reading some journals or more emails. I have to write or review a lot of documents, such as departmental or clinical or research related papers, reports, quality records, etc. I have regular meetings with lab staff, clinical staff, executive management and project teams. In the last 2 years, since I have been working in Australia, I have far less teaching commitments than I had in Hungary, but still give a few sessions to medical students, clinical teams on new laboratory tests and I lecture locally and internationally at various meetings, symposia, or conferences. I run a number of local quality improvement and clinical audit projects, national and international surveys and working groups and I mentor the work of students or scientists in these. During a normal working day there are always a few interesting cases to discuss with clinicians and I am also on various committees or advisory boards which have regular teleconferences. I usually leave work around 6:30-7 pm.
    My EFCC presidency just finished in July this year but beforehand I had a very intense 2 years as I ran EFCC usually after my regular work finished. My so-called “EFCC night shifts” started after dinner and watching the evening news, and lasted from 10 pm till I dropped. Certainly, I would not call this a normal day, but due to the time shift between Australia and Europe and my work commitments in my new job, this was the only way I could do it.
  15. What do you see as the top three global issues facing Clinical Chemistry Directors today?
    • Managing demand.
    • Balancing between consolidation, integration and making labs larger and faster in delivering results by robotic systems while maintaining highly skilled scientific and medical staff.
    • Dealing with financial constraints
  16. Who are your role models or mentors?
    Mentors:
    • Professor Laszlo Fesus University of Debrecen, Hungary) who mentored me as a medical student and inspired me to become a laboratory specialist.
    • Professor Laszlo Muszbek (University of Debrecen, Hungary) who was an exceptional mentor and boss during my postgraduate specialist and PhD training and whose leadership skills and methods serve as a model to me.
    Role models:
    • Professor Tivadar Miko, my histopathologist partner, who is my role model for vision, strategic thinking, intelligence, attitude to life, very high morale, integrity and tolerance.
    • Professor Les Irwig (University of Sydney, Australia) who is my role model for EBM knowledge and wisdom, modesty, kindness, work-life balance, and caring for people and the environment.
    • Professor Sverre Sandberg (Haukeland University Hospital, Bergen, Norway) who is my role model for scientific thinking, leadership qualities and attitude to life and people.
  17. Who is your favorite celebrity/famous person and why?
    I do not particularly fancy the ‘celebrity’ as it is all blown up by the media nowadays. I prefer “ordinary” people whom you can respect for many “ordinary” qualities. So, am I a weird/boring person?
    In general, I do admire all people, whether famous or not, who are revolutionary and innovative in their thinking and who are ahead of their time and dare to push the frontiers and challenge the status quo, as did Galileo Galilei, Isaac Newton, Albert Einstein, Marie Curie, Albert Szent-Gyorgyi, Barry Marshall and Robin Warren, Leonardo DaVinci, Francis Bacon, Pablo Picasso, Luis Bunuel, Oscar Wild, Benazir Bhutto, Martin Luther King, Mahatma Gandhi, Nelson Mandela, Jorn Utzon, Bob Marley, Bob Geldof, Bono, just to name a very few of the “famous” and known; but I could continue this list at length with many more of the “unsung heroes”…
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