- With which professional societies/organizations (e.g. AACC) are you involved?
I am a member of the AACC and active in its Critical and Point of Care Testing Division and the Management Sciences and Patient Safety Division. For the College of American Pathologists I am the Self Assessment Module (SAM) Committee Chair, Chair of the Laboratory Medical Director Working Group, and serve on the Council on Education. I am also a member of the American Society for Microbiology and the Clinical Laboratory Management Association. Finally, I am on the editorial board of the Patient Safety Focus, which is published quarterly in AACC’s Clinical Laboratory News.
- What area(s) do you specialize in and what initiated your interest in these areas?
I began in 1985 at a regional independent laboratory the Mankato, MN (Laboratory of Clinical Medicine). From 1991 to 2001 I was practicing anatomic and clinical pathology in the Midwest at CentraCare Healthcare in St. Cloud, MN, where I lead the group from 1996-2001. Since 2001, I have been at Mayo Clinic in Rochester and Arizona, most recently as the Medical Director of the Laboratories at Mayo Clinic Hospital in Phoenix and Mayo Clinic in Scottsdale, AZ. During this time I have had a strong interest in general clinical chemistry, critical and point of care testing, and clinical microbiology, especially hepatitis and HIV. I have had a particular interest in these areas because they involve interaction with clinical colleagues in order to solve complex cases and often require diligent clinical pathological correlation to solve challenging cases.
- What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine?
I have a lifelong interest in helping to define the role of the medical director of the laboratories and to help train young scientists and pathologists to lead complex medical laboratories. While at Mayo Clinic, we started a formal program in leadership and management. At the time, I insisted that M.D. residents and fellows train alongside Ph.D. fellows in laboratory medicine, because that is the way teams will practice in the future. As we move from individual laboratories to a collaborative model of interconnected laboratories, we are developing a medical system that depends on advanced laboratories that provide effective, efficient, high quality, safe, patient-centered care, education and research. I am particularly interested in helping future and current lab directors to understand how critical their role is, now and in the future, especially in the areas of quality, safety and test utilization. I also have a passion for quality process improvements and safety and I was one of the original faculty staff for the Mayo Clinic Quality Academy and the Quality Review Board.
- What were some of the most rewarding and/or challenging moments of your career?
I love to see mentees advance and contribute to our field of clinical chemistry. I am delighted when I see mentees succeed. There is a word for this from the ancient language of India called Pali—mudita, which is the joy experiences in seeing others succeed. I continue to have frequent contact with scientists and pathologists as they solve laboratory director challenges. I love connecting others. Sometimes I call myself the “concierge pathologist” because I may not always know the answer, but I generally know who does. Then I get to make the network of colleagues, sometimes separated by distance, stage of career, and perspectives, stronger. We have been drawn to this wonderful field. Why not share it with others?
- How would you recommend achieving an optimal work/life balance?
It starts with the leaders of the lab. The leaders should set a good example of being productive at work, while being attuned to our other roles as spouses, family members, parents, friends, and citizens. In Minnesota, we enjoy ice hockey. I tell others that even the best skaters have to take time to “get off the ice,” meaning that we all need to time to refresh, both mentally and physically. Careers are meant to be enjoyed and that means enjoying each others’ company at our national and regional meetings. We need to recognize when we reach the point when we need to take a break and encourage our co-workers to do the same. Otherwise, we are practicing unhealthy behaviors in healthcare. The medical literature shows that once professionals reach the stage of burnout, then it is very difficult for them to reinvigorate themselves.
- What are your predictions for advances in laboratory medicine and/or your area over the next ten years?
I believe that laboratory medicine in general will become more recognized for the critical role that judicious testing plays in illness and health. I predict clinical chemists and pathologists will help colleagues and the general public to understand the proper role of testing. More of us will be involved in helping to define overuse, misuse and underuse of testing. Payers will seek our help to define the best value and to optimize the volume of testing. Patients want the right test, for the right indication and at the right time. Critical and point of care testing will become more sophisticated. We will work more collaboratively with clinicians to understand when to order esoteric tests, and just as importantly, when not to order esoteric tests. There will be unforeseen opportunities for experts in laboratory medicine to mine data, feed the data back to clinicians and refine ordering patterns. Over the next 10 years we will be increasingly recognized for our contributions by both clinical colleagues and the general public.
- What do you see as the challenges facing young scientists in laboratory medicine?
Knowledge in all areas of laboratory medicine is growing exponentially. It will become increasingly challenging to remain competent in one’s field for a lifetime. All of us will face challenges to demonstrate our competency in our chosen field. It is especially important to stay connected with professional organizations so that we will recognize what we don’t know and close our knowledge gaps as quickly as possible. Finally, we need to learn how to move vast amounts of data to knowledge and ultimately, to wisdom. Resiliency is the key.
- What specific goals would you set for young scientists to set for themselves? Any suggestions on how to achieve them?
Especially as young scientists finish their fellowships and start on their careers, it is important for them to honestly assess what they wish to accomplish. If a young scientist is unsatisfied in his or her current track, then they should not be afraid to ask themselves why and to make changes if necessary. A fulfilling career begins with a frank assessment of one’s skills, talents and values. There are diverse career tracks and opportunities. Young scientists should seek out mentors who have found success in their field and are willing to guide them. Seek out mentors in your chosen pathway who can provide the roles of teacher, sponsor, advisor, agent, role model, coach, and confidante. If you remain in an academic medical center, then seek out a wise mentor who can help you optimize your research productivity, efficiency and focus. The AACC has an abundance of very useful resources for young scientists and provides one of the best values as an organization in laboratory medicine.
- What in your opinion has been the most important advancement in science you’ve seen in your career and why?
It is difficult to name a single advancement, but in general advances in applied molecular methods have dramatically changed and continue to change testing in all of clinical chemistry and infectious disease. LC/MS/MS, rapid PCR and genomic sequencing have advanced science and clinical care in ways we could not have imagined over the past 25 years, which is the span of my career. I often tell my young colleagues that I wished I was starting my career over, the advances are so dramatic. The most important “advancement” may be retraining ourselves to think differently, especially given our challenges, including personalized/individualized medicine. We need to be better systems thinkers.
- How did you get started in these organizations and what advice do you have for young people wanting to get involved?
Use your heart to follow your head. If you have a particular interest in an area, please get involved. Your fellow scientists need your contributions and your perspectives. I found that I have always received more than I gave by being involved in these wonderful professional organizations. Don’t hesitate to volunteer for an assignment in an area when you have a passion. You will find others who share your interests and you will be able to contribute in ways you never thought were possible. You bring unique perspectives and your colleagues will be enriched by your experiences.
- What do you think is the most important leadership skill?
Listening. It is difficult to do and I have to practice every day. I like to “listen aggressively.” I don’t learn anything by talking, only by carefully listening, paraphrasing, and letting people clearly know that I have heard them. Whenever someone gives me a suggestion, they are giving me a part of themselves. It is not easy for someone to give the lab director a suggestion, and one wishes to hear that their idea has been implemented, and if not, why not?
- Who is your favorite celebrity/famous person and why?
I admire Abraham Lincoln for many reasons. He showed humility, grace under pressure, a willingness to learn, and a collaborative and inclusive nature. He never took criticism or himself too seriously. He abundantly gave others credit. He had the courage of his convictions and a clear vision of where he wanted the country to go and how to get there.
- What is your favorite place that you’ve lived?
I am living in my favorite place now, Scottsdale, AZ. I tell people that I don’t need to go to a resort, I live in one! I love hosting colleagues from around the country and my wife, Evelyn, and I have a nice casita (apartment-like building separate from our house) that is very welcoming.
- Describe your role as chair of the CAP Self-Assessment Module.
We are defining educational self-assessment modules (SAMs) for pathologists who completed their residencies/fellowships after 2006. These young pathologists are required to complete self-assessment modules as part of the requirements of the American Board of Pathology to demonstrate current knowledge and competency. We are striving to produce high quality, practical and useful SAMs. We have a motto of “collegial coaching for competency.” We want pathologists to be competent in order to be successful. The SAMs cover anatomic and clinical pathology, special topics and leadership/management. Clinical chemistry scientists can take the educational modules for educational credit. So a clinical chemist could participate in the educational portion of the leadership and management modules, for example.
- What are some useful approaches you use to ensure effective test utilization?
Similar to kindred spirits like Dr. Mike Astion (U. of Washington) and Dr. Brad Brimhall (U. of Mississippi), I like to use site-specific laboratory data to help persuade colleagues to take the most effective route to ruling in or ruling out a disorder. I have become more assertive in prohibiting some tests without permission, streamlined and controlled the number and type of reference lab testing, and required literature-supported evidence to support a request for an unusual test. Laboratory directors have used this approach for years with success in transfusion medicine to guide optimal blood and blood product utilization, so most physicians know that their practice patterns will be scrutinized. We have up to date, evidence-based algorithms which help guide our laboratory medicine utilization through our reference laboratory, Mayo Medical Laboratories. Our clinicians are thankful to the laboratories for the guidance. We also have a clinical practice committee that addresses test utilization and a Department Grand Rounds that provides updates on new tests.
- Do you have any other specific comments or advice that you would like to provide to the members of SYCL?
As a pathologist, I consider it a very high honor to work side by side with clinical chemistry scientists. For example, I have the privilege of working in Arizona with Mary Burritt, Ph.D., former President of the AACC and an inspiration to all. We complement each other and we are a good team. Clinical chemistry scientists should be secure in their knowledge and recognize that their contributions to patient care, education and research are immeasurable. In the future, SYCL members should seek out collaborations with physicians in pathology and other fields. In our organization, both pathologists and clinical scientists are called “consultants” and both are respected and valued.