- With which professional societies/organizations (e.g. AACC) are you involved?
I am a member of AACC, NACB, ACS and AAAS but my active professional involvement is with AACC and NACB.
- How did you get started in these organizations and what advice do you have for young people wanting to get involved?
My initial involvement in AACC was directly the result of advice and example of my training mentors at Wash U. Per advice of many previous MoM commentaries, it is most often the case that development of involvement requires only self-identification of the desire to be involved. You should certainly start with active involvement in your local section of AACC, including unreserved willingness to hold office.
- What area(s) do you specialize in and what initiated your interest in this (these) area(s)?
My training and fundamental expertise is in physical biochemistry, and my greatest interest within clin path is in endocrinology. The control circuits inherent to endo are very appealing to someone with an engineering background. My development of some degree of expertise in endo is derived also in part from the fact that inquiries to the lab in this topic area are frequent. I have had the most technical fun in use of mass spectrometry. The impetus for this exposure was the lack of a commercial immunoassay for rapamycin when it first came out. Professionally, I benefited greatly from that peculiar circumstance.
- What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine?
My most important contribution to lab med literature has been a detailed delineation of the physiological mass balance for anhydroglucitol (AG), to explain its limitations for utilization as a lab test -- fairly esoteric, so probably not that important, but it's my most important academic contribution. AG is essentially a high-side marker for hyperglycemia which can, under certain limited circumstances, supplement the information content of A1c testing; its potential use was discussed briefly in one of last year's A1c CAP surveys. Otherwise, I would say that service on the board of ABCC enabled me to be involved in certain initiatives that have been of benefit to the field, especially my involvement, along with others, in the years-long process of alteration to CMS regulations to enable board certification much earlier for most examinees. It's likely that all of you will have an opportunity during your career to serve on ABCC, and I can promise you that it is an important and worthwhile undertaking. Other than that, I think (parallel to Stan Lo's previous MoM commentary) that my involvement in pathology resident education over the years is that which will ultimately have had the greatest lasting positive impact.
- What were some of the most rewarding and/or challenging moments of your career?
Well, first I will have to say that I have probably had two careers -- I came to clinical chemistry rather late, some five years after my PhD. Scientifically, my dissertation was a thrill that (I will admit) I have not equaled. I saw a reference to it in a review paper some 20 years on. In clinical chemistry, I think progression of projects to publications have in all cases been highly rewarding experiences. Work in mass spectrometry has been highly rewarding, it is such a beautiful thing to work with. Last, I had the privilege of serving on the newborn screening advisory board in Nebraska for ten years. This was highly rewarding in that, as the sole clinical chemist, I was often called on to inform the proceedings from a technical standpoint, which role I know was greatly appreciated.
- How would you recommend achieving an optimal work/life balance?
I think optimal balance has great variability among individuals, and it sorts itself out, always, according to one's desires and best self-interests. And, of course, you probably mean work/non-work balance, as work certainly is a large part of life -- and for us, happily, it is most often an enjoyable and engaging part of life.
- What are your predictions for advances in laboratory medicine and/or your area over the next ten years?
Ten years is a fairly short time but I think there will be substantially greater deployment of expert systems to guide (or even control) test utilization, and I think there will be ever-increasing deployment of increasingly-highly-capable and cost-effective POCT. Fully automated central lab systems will become more common, even in small hospitals.
- What do you see as the challenges facing young scientists in laboratory medicine?
The main challenges are also opportunities -- to develop and apply new science and advanced technology in new ways. For instance, I think clinical chemists will play a large role in reshaping the state-of-the-art in clinical microbiology via applications involving mass spec. So, clinical chemists will need to know a lot more microbiology. I think that pure business pressures to reduce costs of lab operations will be a constant challenge. Administrative and regulatory burdens will only increase, never decrease. Offsetting, I think increasing reliance on advanced technology will make the value of the technical expertise of clinical chemists more readily apparent, and we will therefore become more valued by a greater number of differently sized institutions.
- What specific goals would you recommend that young scientists in your discipline set for themselves? Any suggestions on how to achieve them?
One great aspect of this career is that it is virtually always the case that you learn something every day. Recognize that you can never know enough, and that you should always maintain a regular program of study. Spending x amount of time per month for study or for reading of primary literature should be a goal. Related, you must strive to maintain a forward position and perspective that enables you to assess what's on the horizon; that is almost certainly a part of your job.
In the short term, you should always keep a list of specific short-term and long term goals in front of you.
- Do you have any other specific comments or advice that you would like to provide to the members of SYCL?
Well, there a number of things that I have learned over the years that I think are useful to put into words.
Especially for inquiries related to clinical problem solving, you should always maintain a clear distinction between what you know as data (I was told this) and what you know as fact (This is true). In my experience, it is fairly common that essential elements of a problem statement are incorrect or misstated. Confirm the essential factual aspects of a problem first. You may otherwise be trying to solve the wrong problem. Note also that problem statements often come with specified solutions (We need you to…) which are also often decidedly wrong for the same reasons. Always regard (politely, privately) such specifications simply as data (I was told this).
Recognize that organizations behave essentially as biological entities. The fundamental preoccupation of any organization is to sustain itself, and, a close second, to exploit any opportunity to expand its province. From a managerial standpoint, the value of your presence and activities are assessed in this framework. Think clearly and way ahead about your responsibilities in this simple context.
Censure your academic prowess and delight for learned criticism and debate, unless it really matters. That scripted Six Sigma project, with poor premise, a-scientific design, bad data, and inappropriate statistical analysis? Leave it alone. In cases where you do need to openly criticize or argue, do so only with complete dispassion.
It is important to actively cultivate relationships with your clientele. Introduce yourself, ask for invitation to meetings, ask for invitation to give talks. My experience with this approach in medical school settings has been overwhelmingly positive. Ask to get on the residents' didactic lecture rotation for endo, for internal med, for ED. Advertise yourself as the go-to person for all things related to lab, available at all times. And make sure that your pager is covered 24/7 when you're out of town, that there's never a gap in this service.
Be very visible, well-known and always available to lab staff. Walk through the labs regularly and greet people -- daily -- even if you have no other specific business there. Know how things actually work in the lab first-hand. Spend time on second and third shifts.
- Can you provide a tip for interviewing job candidates?
To the extent possible, be knowledgeable about the history and organizational role of the individual people you are interviewing with. In academia, that's fairly easy, although it's perhaps not so easy in other settings. During the course of the interview, attempt to identify the person to whom you would be primarily responsible – it may not be the person designated on the organizational chart! If discussion of POCT comes up unexpectedly, call a cab! And, if POCT does not come up, inquire as to whether this might perhaps be some error of omission; ask to see a living person in the capacity of POCT director, and ascertain that they are qualified and evidently in good health; otherwise, call a cab! Last, if you face a scripted interview at any stage of the process (Tell us about a time when you made an important decision!), I would regard it as a very bad sign with respect to the ability of the organization to properly assess or value your credentials (Answer: I just now decided to call a cab!).
- If you could start your career again, what would you do differently?
I’m not sure that I would do much differently – I have benefited greatly and in different ways from the diverse educational and work experience that I have had, and I would hate to forego any of that integral fund of knowledge. Truth is, most of us are where we are via a series of chance circumstances. I know very few people that have had highly directed career goals -- people whose expertise and interests they could have correctly described early on for their future selves. But, among pursuits that in retrospect I now know that I would have liked, one would be formal training in metabolic and genetic disorders.
- What is an average day like in your life?
Meetings, mostly! Mondays, AM starts with weekly CP case conference. Otherwise, AM starts with review with resident of PE and Hb gels from the previous day. I then make a need-to-know tour through the lab, and meet with the lab supervisor to discuss any pressing or pending issues. I pursue writeup/documentation issues during any remainder of AM. PM usually starts with meeting with resident, working on pending inquiries, general lab issues such as method validations, or along syllabus content or a research project. The time here is variable, from half-hour to 2 hours. Depending on the number of administrative meetings scheduled throughout the week, I may then have variable amounts of time available to choose to work on what is most pressing (or interesting) for the remainder of the day. There are generally some 50 separate short-term and long-term topics on my pending list at any one time.
- What excites you most about your job?
I am pleased with the variety of topics and the large number of people that I interact with on any given day. It's never dull. Moreover, in settings I have worked in, the role of the clinical chemist has been a unique (island) niche, and so there is great responsibility, challenge and satisfaction of making final decisions on a variety of matters of importance on a day-to-day basis. I also like working with many highly competent, dedicated people.
- In your opinion, what are the benefits of becoming a member of AACC’s Academy, NACB?
The benefit lies primarily in the opportunity to formally be part of the academic activities in which NACB is involved. Secondarily, there is benefit to know and be known to the people engaged in those activities.
- What else might you care to add to this interview?
I am very impressed with the quality and wherewithal of the many SYCL members coming up through the field. We are all indebted to the dedicated service of the outstanding faculty in the ComACC programs. It is contingent on all of you to maintain this great tradition in what is a very esoteric field!