- This is Lab Medicine Rounds, a curated podcast
for physicians, laboratory professionals and students.
I'm your host, Justin Kreuter,
a transfusion medicine pathologist
and assistant professor of Laboratory Medicine
and Pathology at Mayo Clinic.
Today we're rounding with Dr.
Chancey Christenson transfusion medicine pathologist in the
Department of Laboratory Medicine
and Pathology at Mayo Clinic in Florida.
Thanks for joining us today, Dr. Christenson.
- Well, thank you so much for having me.
I, this is really exciting.
I'm really looking forward to talking you about all of this,
- So, absolutely.
And also, I guess we should say
that this is the Lab Week episode, so
we're really privileged
to have you leading the charge on Lab Week
and having this released.
And encourage the listeners as you listen to this podcast,
please share with your communities.
So, Dr. Christenson, let's kick things off with, you know,
since this is a Lab Week episode,
just maybe from your perspective, why is it important
to highlight the extensive presence
of the laboratory in current medical practice?
- Thanks for that question, Dr. Kreuter.
You know, I think there's a, a bunch of different groups
that would be, that really need
to understand the importance of the lab.
You know, I think just as a general overview, I think it's,
I'm sure your audience is well aware of this, is
that the lab does more than just
run a test and analyze it, right?
It helps, you know, pick the,
select the tests that are appropriate.
It helps pick the panels.
It curates its own test catalog
to get rid of apps today tests.
It provides accurate and quality results.
It manages how they're ordered
and even sort of manages access so
that it's not just the first year resident
or the most expensive test as well.
So more generally, I think it's important to have that.
I think for, it's important for the staff to know
how important they're, you know, they're,
they're really highly trained.
They have really specific set of skills
and I think that sometimes the lab,
because we're not directly patient facing,
we're not recognized, but I think it's really key
to highlight, you know, their hard work
and really they're the driving force along
the hospital as well.
For patients, I think it's important to really highlight
providing accurate and timely results.
You know, I think that so many medical decisions get made
based on clinic, on laboratory results.
And so I think for patients having that timely result,
you know, I always think about if I had a family member
that they went to a doctor, they, they found a lump, right?
And that say a three day weekend happens, you know,
they're sitting there and stewing that the whole time.
So it's really part of the, the laboratory's job is to try
to provide accurate time and results.
And if it's bad news, you wanna try
and sort of say, what does this mean?
Here's some basic guidelines more than just Dr.
TikTok, you know? So I think those are important as well.
I think in terms of clinical aspects, I think that,
you know, this is from, is from Mayo itself,
but 70% of the electronic health record is made of lab data.
And obviously I think that number has probably changed based
on radiology.
And maybe it's increased because we have genotyping,
but there's a lot of value
and critical decisions really are made based on that.
You know, if you talk about a tropo,
a third troponin level versus a second troponin level
that determines whether you get access
to whether you're admitted
or whether you're discharged, you know,
or whether even though it doesn't take very much volume,
the top line diagnosis of a pathology report can certainly,
certainly impact the treatment level as well.
So, and finally, you know, the big boss,
we gotta talk about administration, right?
They really need to know why it's important, you know,
because so much of the time that they'll,
they look at the lab and say, oh, it's just cost
because it's not directly patient facing.
And I think it's really important for us to sort of work
to highlight our value, right?
It's not just that the volume is 70%, it's
that value over volume, right?
And so the lab, the usual statistic is it's 3%
of the total cost of a hospital.
So even if the, if the administration says cut your budget
by 50%, we're saving one and a half cents per dollar.
You know, that's not very much to talk about.
But if you talk about something like a patient blood
management program where you've avoided to,
you've avoided giving patients transfusion studies should
have shown that you can have a reduction in length
of stay by up to three days.
So if you start saying three days discharge sooner, that's
what the administration starts sitting
up and start taking notice.
And so all of that is really a more holistic approach
towards what is the value of medicine, right?
It's not the surgeon saying, well,
we should decide transfuse or not.
It's really the dedicated transfusion medicine doctor
saying, well, here's the evidence
that supports, when do you transfuse?
Why are transfusing maybe blood?
They don't need to be transfused. So,
- Oh, I love how, in your answer there, you start off
with highlighting and outlining really the professionalism
of the laboratorian, right?
So that, you know, our listeners
during lab week now can kind of take stock of, you know,
recognizing what are all these elements of the work
that they do in terms of curating,
making sure things are appropriate,
making sure things are accurate, timely,
that professionalism is just an awesome way
to highlight right out the gate.
And then I also love how you're highlighting how we're
not patient facing in, in most situations
and so can be taken for granted,
but that you're highlighting, right, with your story
of if you had a family member with a lump, you know, very,
very quickly you realize that having
the laboratory present with answers
really matters a lot.
So I, I think it, it highlights this, this importance that,
that we're celebrating here with lab week.
Now, you know, a lot of us right, didn't come out
and were born into a world
where we understood laboratory medicine.
And certainly stories are always fun to recount.
And I'm kind of curious for, you know,
what's your story when you kind of first became aware
and really appreciated kind of this extensive role
of the medical laboratory?
- So when I was a medical student where I worked,
we had paper charts.
And so I remember there's a lot of delays in trying
to find the chart you're trying to run around.
And then also, I remember when we were rounding, you always,
as a medical student especially, you had to go
and you, you had to write your wishbone
and you had to like print out your sheets of paper.
And so it's quite a labor intensive process.
And then I also saw how, you know,
critical decisions are really made based on that, you know,
when patients, are they gonna be able, eligible
to discharge while waiting on the labs?
You know, are, are they, is their care need to be changed?
Do they need to go to higher level care?
All that really depends on
and critical points were really made trying
to waiting for these labs.
And so I really saw the benefit of as well,
and the impact was having the patient care
and sort of as a more systemic approach
what I was working on a QI project for, you know,
the troponin levels about, you know, getting rid
of the third one and you know, working
with the emergency room versus the pathology
and really just focusing on the impact of this is
for patient safety and for patient care,
but also you're talking about getting people out the door
eight hours or even a day earlier.
And that really is impactful,
but for the patients not having to be in the ED,
but also getting more people in beds, helping things out.
So really I was just, it was incredible to watch the,
how much just that single lab result alone could have all
these downstream effects.
It's like I'm really interested in the idea of labs
and how do we make them better and how do we improve them
and how do we, you know, what is our role as a pathologist?
- Yeah. Yeah. I really appreciate that.
You know, that leads into my next question.
So you're talking about kind of working with a team there
to, to improve things.
I'm curious if you could share how do you
and your team work together for efficient patient care?
- Sure. Well, I would just like to stress also
as another transfusion medicine doctor, I'm sure you know,
but you really can't have a hospital
if you don't have blood, right?
So if you don't have blood in a hospital,
you don't have an ER, you don't have an OR,
or you don't have an ICU, you really don't have anything
that you would think of as a hospital.
You have like a, a minimally invasive outpatient clinic.
And so I really try, same
- Thing, that same thing could be said for chemistry,
hematology, micro.
So just wanna say we are very inclusive on this podcast,
especially during lab week,
- Right?
I did not mean to disparage those other ones.
I just, my own field is you can't really run a
hospital if you don't have a lab.
And I think that it's, so I try
and stress to my team all the time about that.
I try and meet with them at least a couple times a week.
I try, we have constant communication between
the administrative aspects and the,
or the supervisory aspects as well.
So we're basically daily contact.
I really try and let my team feel like they're heard
and really feel like they are, have the ability
to express themselves
and you know, they're able to have, you know,
voice their concerns as well.
So we have a weekly huddle as well.
And then really at the end of it,
we really try and tie back.
So we recognize when people do a good job, if it's a good catch,
or even if they have cases where
what they have done has directly impacted patient care.
So just as a great example, we had a recent case
where we had a really expanded buffy code.
And so one of the blood bank technologists came to me
and said, I think this patient may need leukapheresis.
So I was on my way to go call the hematology service
and they called me and said, oh, we have this patient
that needs leukapheresis.
I was like, just by being able to see it in a tube,
this blood bank technologist really was able
to catch something at the same time that the hematologist,
it was basically the same time the lab results resulted was
they had come to us.
And so it was really, I try
and bring up instances like
what they have done in the lab really has
directly impacted patient care.
- Yeah, absolutely. And I could see
that story totally going another way, you know,
if somebody is in the ED
and you know, somebody's not making the connection
of needing leukapheresis, I mean, in this particular case,
your story, this was redundancy, which is great,
but I don't want anybody to hear that story
and say, oh, hematology was calling anyway, right?
So no, it highlights that value. And I, I really dig that.
So when I hear you talking, I hear you talking about really
cultivating safe spaces.
Maybe that is a little bit too much buzzworthy these days
to talk about, but certainly I understand the value
of your team being able to talk.
'cause that's how you're able to
really leverage their professionalism
and what they can bring to the table.
I, I imagine,
and maybe I'm assuming too much,
that when you came into this position, you had
to work at creating that environment
that maybe there were some setbacks.
I'm curious, do you have any kind of thoughts, advice for
how to kind of move through setbacks in creating
that environment where people feel empowered to speak?
- I do think that there was certainly some aspects
of the culture where they felt maybe a little bit afraid to
that what they said was gonna be, you know, used punitively
or that, you know, it made people afraid to speak
and it really made them sort of a afraid to
highlight problems.
And then, you know, you and I, I really tried to encourage
and talk to them about, you know,
I'm really trying to listen.
I'm not trying to punish you.
I'm really just trying to know if there's a problem
in your workflow.
It's really up to me as the leadership
and as the director to try and get rid of that as well.
And so I really tried to, you know, reassure them that
we're not, we're not looking for problems just for problems.
We're not looking for problems to punish people.
We're really just trying to say what's,
what is the actual problem and how can we fix it as well?
And so I think it took a couple of false starts
of just constant reassurance that we are, in fact, you know,
the leadership is really here for the staff
to help make sure that their work environment is good
and they feel supported and they feel empowered
to make their decisions.
But I think that we have a good settlement now,
and I think people feel a lot more comfortable saying,
you know, the leadership is listening
and they're responsive to our needs.
- So for our audience to know, I mean, I, I really wanted
to get Dr. Christenson for this special lab week episode
specifically because I, I feel like you're such a driver.
In fact, you're probably one of my colleague
that I'm most interacting with
who's always pushing the practice forward
and always asking critical questions.
And so I'm a little curious what you're gonna say
to this next last question that I wanna ask you is,
how do you see the role
of laboratory evolving in the coming years,
I think the laboratory is gonna have a lot of
importance in the coming years.
You know, I think that there's a lot of evolving technology
and I think there's a lot of things
that are really coming up that'll be really exciting.
So I think one of the big ones is I think CRISPR
and gene therapy, you know,
I think it's coming in a big way.
I know that's specific to our field,
but it's, you know, the study
of it is gonna be a big field if you just sort
of talk about genomics
and then proteomics in general,
that's gonna be a gigantic field.
I mean, I know precision medicine has sort of went
through a lot of hype and then it sort of has faded away.
But I think that the new tests
and the new assays are really good about talking about not
just effectiveness of not just targeted therapies like CAR T
and you know, different monoclonals,
but specific things like talking about like
vaccine inverse vaccines for autoimmunity.
Or if you're talking about things like even,
you know, drug genotyping, right?
So they're saying even 40% of statins don't work
for the population, let alone three quarters
of the cancer drugs don't work, right?
So being able to provide targeted therapy quicker instead
of having to sort of these trial
and error is gonna be a big realm, I think as more
and more assays of
what is the genomics, what are the markers mean?
What are the proteomics and how that field is gonna expand.
I gonna be a lot of realm for pathology to play a role.
I started to think another one that's really important is I
think that there's a lot more at home testing
and a lot home more POC testing.
So just if you think about send out kits,
you're talking about cholesterol hem, A1C thyroid panel,
vitamins, hormones, allergies,
sexually transmitted diseases, fertility panels,
tests like Cologuard.
I think that's gonna rise more and more.
And I think we're just keep
discovering more and more biomarkers.
So being able to have the convenience of working at home,
take the test, send it in in two
or three days, get your results back as opposed
to take time off work, go get your labs drawn, do all that,
get it back and then have someone call you is gonna be a big
realm for them as well as well,
there's gonna be things like home-based at-home monitoring.
So right now we already have anticoagulation like home INR
monitoring and then obviously things like CGMs, right?
So the wearable and all of that is how does
that integrate into smart devices?
And, and when you have smart
device, how do we interpret that, right?
So our role is really gonna be working on those
and how do we keep ourselves visible?
How do we maintain, you know, working the space
and say, what does that mean?
Oh, you have a glucose of 6,000 from your home
monitoring, you know, what does that mean?
As opposed to like, what's,
what's your regular test as well?
So I think we have a really important role in terms
of the evolving wearables and smart technology.
I find sort of, I think a really important role is that,
as I mentioned before, I think it's important for us to sort
of provide answers of what the tests are and what they mean.
Because I think a lot of people do get their information
from like Dr.
Reddit. And so I think, you know, if you get a test result,
you should sort of have reliance on what it is.
And it's really up to the realm of pathology.
Our clinical colleagues are so busy
and so overworked that, you know, if they get a an array
of tests, it's hard for 'em to sort of explain what is,
I think we have a good role
and we can use things like AI technology or Dolly
or things like Sora to sort
of even make in-home videos, right?
So here's your tailored, what is your elevated glucose,
what does it mean to, for diabetes,
what is a high thyroid panel as well?
So not just a couple sheets of, you know, just a paragraph
or here's a sheet of paper at discharge,
but literally like, here's your tailored avatar
that explains what did these results mean to you as well.
And sort of finally, you know, within our own field,
I think there's a couple ones I think will coming up.
I think that the lab was super important, as you may have
or may not have noticed, there was a little bit
of a bug going around in 2020 and 2021
and 2022 in 2023.
And actually there was, since the start of the 21st century,
there's been sars, mers, Ebola,
Zika and Covid.
And I'm sure I'm missing a couple others.
So there will always be newly rying diseases.
You know, even in our own field we're talking about
convalescent plasma.
So having new diseases in a warming climate
and then the ability to rapidly develop tests was a key part
of our covid response.
But also convalescent plasma will be arising just
as a method to treat whatever novel diseases they arise
and sort of as the far futures, or not as the far future.
But the, a little more sci-fi one than I would think of is,
you know, with our own field, I think some
of the inventions we're talking about is
universal blood substitute.
We're talking about RBC pathogen inactivation,
and I think even, it's a little bit hooky dokey right now,
but I think talking about things like deriving youthful
factors for blood, right?
So there's already young plasma for Alzheimer's treatment.
I think whatever the case of that,
I think we will refine whatever that is
and have an actual targeted treatment for diseases
of aging as well.
And sort of just within our own work,
I think the evolving role of the laboratory is how do we
develop and implement
and then validate different algorithms, right?
So we can improve our own workflow,
improve our own efficiency,
and sort of just help ourselves in our own job as well.
- That was the perfect lab week answer to
that question of how is the lab evolving, right?
The lab is everything is the theme of this year's lab week.
And you started off your answer talking about really like
new technology and how that's gonna be driving stuff.
You then were talking about
how the lab is gonna be playing an increased role in
therapeutics
and then even, you know, the stuff
that probably people aren't as, you know, enamored by
but are, are certainly our patients really care about is
sort of at home or the way that they can get this testing.
How can we make it easier?
And of course it makes my heart go pitter-patter
to hear about really being able
to explain meaning to a patient.
Yeah. So I, I think huge.
Thanks for routing with us, Dr. Christenson, take thanks
for taking the time with us today.
- Yeah, definitely. Thank you for having
me. It was great talking with you.
- And thanks all our listeners.
Thank you for joining us today.
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