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In this episode of “Lab Medicine Rounds,” Justin Kreuter, M.D., sits down with Curt Hanson, M.D., professor of Laboratory Medicine and Pathology, a hematopathology consultant at Mayo Clinic, and executive vice president and chief medical officer for Mayo Collaborative Services, to celebrate Lab Week 2022 and discuss why it’s important to look at our past when planning for the future.
A Mayo Clinic podcast for laboratory professionals, physicians, and students, hosted by Justin Kreuter, M.D., assistant professor of laboratory medicine and pathology at Mayo Clinic, featuring educational topics and insightful takeaways to apply in your practice.
(inquisitive electronic music)
- This is "Lab Medicine Rounds,"
a curated podcast for physicians,
laboratory professionals, and students.
I'm your host, Justin Kreuter,
the bow-tie bandit of blood,
a transfusion medicine
pathologist at Mayo Clinic.
This year's theme for lab
week is "Back to the Lab,"
celebrating our past as
we look into our future.
So we thought it'd be fun to
celebrate this year's theme
by sitting down with one
of our laboratory leaders
to discuss why it's important
to look at our past when
planning for the future.
So today joining us is Dr. Curt Hanson,
profess of laboratory
medicine and pathology,
a hematopathology consultant
here at Mayo Clinic
and executive vice president
and chief medical officer
for Mayo Collaborative Services.
So thank you for joining
us today, Dr. Hanson.
- Oh, you know, I first
saw your invitation,
I thought Justin's
looking for the oldest guy
he can find to add to his calendar here.
So thank you for asking me by the way.
- Yep.
Our audience is looking for the wisdom,
and I know you've got it
in spades for us today.
- We'll try.
We'll try our best.
- So from a leadership perspective,
as I did your introduction, you know,
you really have a lot of leadership roles,
and certainly you've served
for a number of years
in a number of different hats.
You bring a lot of different perspectives
to laboratory medicine and leadership.
And so, you know, why is it
important from your perspective
for us to look at our past
when planning for our future?
- That's a great question.
I think that one of the first
things that comes to mind
is it's an opportunity to
re-look at and validate
what our principles are.
Too often, we just keep
going down the path.
We're busy, you know.
We do today, you go to today's list,
and you do today's list,
and you worry about yesterday's things
you didn't get it done.
And we don't take the
time to really sit back
and reflect on what's my
vision, what are my principles?
And am I upholding those?
Are they still valid?
Do they still work for us?
How can I incorporate
them more into what we do?
And I think by looking
back, you can really go,
"have I been cons consistent over time?
Have we been consistent over time
with why we do what we do?"
And I think that's really something
we don't spend a lot
of time thinking about,
but that really should drive what we do.
It certainly should
drive our decision making
and our planning and our
prioritization of things.
The other thing that comes
to mind and is pretty,
I think pretty obvious is
you need to always look back
to see what worked and what didn't,
but you gotta be careful,
because times change.
I'm involved in a situation right now
in which I'm looking back to how and why
we did things many years
ago and kind of going,
I'm consistently going, "what worked,
what didn't work back then,
but then what's changed?"
And I think that's, what's
really, really critical is,
people always say, you don't wanna repeat
your errors from before, but I
think what you gotta remember
is that the situations change
and you have to interpret
yesterday's either decisions
or failures in light
of what you know today.
And I think that's a really
important thing with it all.
You know, change, it
comes with change, right?
I mean, change is such an important thing
of what we do and we
can't be scared of change.
And I think by thinking
about principles and vision
and what you've done in the past,
there's been seldom that
I've run across something
that I haven't encountered
in the past in some variation
or version with it all.
The last thing I'd probably say is
you need to take time to
look back and celebrate,
especially if we got lab week coming up,
think about how hard we press, Justin,
on trying to get everything
done, everything we do.
We need to set back a
little bit and kind of go,
think back a year, think
back two years, three years.
And everybody, if they
took the time would go,
"wow, look at how much we've gotten done.
Look at what we've accomplished."
And I think that we need to make sure we,
you know, don't be hard on
yourselves or ourselves.
Let's look back, be proud
of what we accomplish,
celebrate our accomplishments,
because that keeps you
going for the next year
if you can find that
sense of accomplishment.
I hope that makes sense to you, Justin.
- Absolutely!
I really like how you're highlighting,
what I'm hearing is that
change is this constant.
And if I can paraphrase,
it almost sounds like,
you know, there is natural,
a drift that may occur
and so that we wanna make
sure that the changes
that we're making are purposeful.
And I think I hear you
highlighting this kind of,
how do we kind of reflect on,
we need to take time
to critically reflect,
and I like that you're asking,
pulling out that third
question, not just, you know,
what did we do well, what
did we not do so well,
but also the what's changed?
'Cause I think a lot
of us, myself included,
aren't necessarily thinking
about that third question
and certainly context in some ways
might be one of the best
drivers of learning.
- Well, just, I mean,
think about, you know,
policy, finance, people.
How the people have, you know,
are different and changed.
And you know, our knowledge
is clearly different today
than what I might have been five, 10,
certainly 20 years ago.
- You know, let me just play,
we're just kind of
sticking in this kind of
getting things off in the why focus.
I think I've heard some people sometimes,
if I'm to play a little bit
of devil's advocate here,
kind of like about your
purpose of celebrating
our successes and celebrating
the work we've done.
I completely agree with you,
but I think there's some people
sometimes that feel like,
well, "hey, this is my job.
And, you know, I shouldn't, you know,
that's good that I'm doing my job,"
but sometimes people
struggle with celebrating,
and I think also maybe
some people, you know,
get nervous about that
taking time to celebrate
our accomplishes that have been.
What's your perspective on that?
- Well, I mean, it's a part
of being a person, right?
I mean, there are, you know,
there's all types of
people that we work with.
There are people that, you know,
they just put their head down
and it doesn't matter
their degree, their title,
whatever it is, boy, they just, they work,
they come in every day,
they work really hard,
they don't want kudos,
they just wanna do their job and do it.
And there's others that, on the other end,
there are people that need motivation
and that's normal.
And I think it's our job as leaders
to use whatever tools that we have,
like this looking back and
reflecting on accomplishment
to keep people motivated.
And then the majority of
people are in between.
You know, we've got folks
that really always wanna work,
but, you know, we need to make sure
we take a little bit of
time to celebrate them,
to thank them.
And that's what lab week
is great for, right?
I mean, I think it is a time to sit back
and really kind of go, "wow,
what a great profession
we work in and the people that we have."
And it's a wonderful time to
be able to do that, Justin.
- Thanks for keeping the
humanity in it, right?
We're patient centered,
but keeping the humanity
in our work is key.
So what are one or two aspects
of pathology lab medicine's past
that you are thinking about
celebrating this year?
- What's that, let me think.
You know, there are
two, I have two stories.
I got two stories I gotta share with you.
- Stories are the best.
- You know, I'm in the, as
I tell people, I'm partway,
I'm a good portion through the
fourth quarter of my career,
so I'm entitled to reminisce
a little bit, okay?
When I started, I started at the,
my first job was at the
University of Michigan, 1987.
So you can do the math.
And a senior laboratory
director at that time
who I really respected, he came to me,
this was very early on in my time there.
And he said, "Curt, during your career,
you're gonna see two
changes in technology."
And that was being
really forward thinking,
because that was going, "wow,
you mean every 15 years,
I'm gonna go through two major changes
of technology and knowledge,"
and that was really being kind of forward.
And now it's like, "good
Lord, it's every 15 months,
there's something new."
And, you know, I was just,
I actually was talking
to a patient this morning and they had
a very problematic history,
they had traveled to Africa,
came back with symptoms
that were really different to define,
and eventually ended up here at Mayo,
and we did our workup,
turned out to be a hematologic disease,
they did the genetic workup,
and they found some really unique findings
by doing NextGen sequencing
and understanding the gene
anomalies that were discovered.
And that technology was
barely going five years ago,
the knowledge about these particular genes
has just emerged in the
last couple of years.
And I think that that
patient's experience was,
you know, he came here in 2020,
he wouldn't have had the
same experience in 2015,
let alone 2010 or 2000
or 1987 when I started.
So that pace of change is something
that is really amazing to me.
And I think our folks in the lab see it,
but we really need to acknowledge
that it's both good and bad, right?
I mean, it allows us to
take care of patients
in amazing ways, but it
also puts a lot of pressure
and stress on our staff,
because there's always
something new coming at 'em.
You know, that type of thing.
So that's one story that
will always stick with me
and I laugh about it now,
but at the time it was like,
"wow, you know, two?
I'll go through two changes," you know?
And like I said, that was
two last year, I think,
if I remember right.
The second story was I started residency
in lab medicine pathology
up at the University of
Minnesota almost pretty soon
40 years ago in 1982.
And I remember this to this
day, that my first lab rotation,
everybody starts on off
in autopsy, you know?
So my first lab rotation
was in the clinical hematology laboratory.
And I remember, I walked in, I was what?
I don't know, 25 and green.
I looked like about 18, just off the farm,
you know, that type of thing.
And I looked around the lab and I thought,
"oh my God, these people,
these texts are going
to eat me for lunch."
You know, because they were so impressive.
They knew everything.
They were working hard.
They were organized and I swore that day,
I really, I said this to myself is,
"I gotta get in their good graces
or I'm gonna get killed here."
And that was my first lesson in, you know,
our best asset are our
laboratory technologists,
our clinical laboratory scientists.
They are incredible.
And I learned so much from them.
Every day I learned tidbits of knowledge.
And very humble, and they would just say,
"Dr. Hanson, I think you
ought to do," da-da-da-da-da.
You know, words of wisdom,
you know, type of thing.
And to this day, if you
need to know something,
walk through the lab and ask the techs.
When there's a problem, they know it,
they know where the
problem is coming from.
They know the problem docs out there.
They know the great docs out there.
We don't ask our CLS, our lab folks,
enough questions because frankly,
they're are biggest asset that we have
and they know so much.
And that's the one thing I
don't want us to ever lose.
I saw it in day one of me
walking into this profession
and it's still true today.
- Those are wonderful stories.
I mean, so it sounds
like you're celebrating
the pace of change, the
history of the pace of change
that we've had in laboratory medicine,
and then the quality of
people that are attracted
into this profession of
medical laboratory science.
So how do you see these
aspects that you're celebrating
informing kind of the future, you know,
kind of the future projections
of success in our field?
- We have to be ready for change,
and I think there's actually,
there's a lot of discipline
out there that has been,
and you know this Justin,
that's been developing.
I mean, you've been a part of that,
that's been developed over time about
how do you deal with change?
How do you make change successful?
How do you incorporate change?
And I think we really,
we need to move beyond
some of our historical
approaches to things
and really kind of grab
that discipline of change
and really drive it in the laboratory
and challenge how we do things.
Think about how we
organize our laboratories.
They're either by technology,
or they may be by a
particular medical discipline,
and we should challenge the heck out of,
and go back to what I just talked about
with that NextGen sequencing
and genetic things,
how much that's changed how
we work out particular things.
I think we really need
to challenge ourselves
as part of this change process.
How do we organize ourselves?
What is the right way
to put a lab together
to maintain it for the
future, to get the most,
you know, medical and
scientific knowledge out of it.
And I think the second thing is gonna be
right off that story that I told you.
Our people are our assets.
Period. Straight up.
We don't always recognize that,
we certainly don't celebrate it enough,
we don't ask enough of them.
I have, what I've always found is that
you can't get something out of people
if you don't ask something of them.
And I have seldom found laboratory people
if by asking them to do something,
seldom do they not achieve it.
We just often don't ask enough of them.
I mean, not working harder,
but how to use their head and their brain
and their problem solving
and all that type of thing.
I think that looking back,
that's the one thing that's been constant
is the skillset of our people
and therefore the need to really recognize
and include them in the
process here going forward.
Hope that makes, I'm
rambling a little bit,
I hope that makes sense, Justin.
- No, this makes perfect sense.
And I see, you know, this
kind of thread continue
about really questioning these assumptions
that we've come through,
but as you're talking about this constant
of the quality of our team in the lab,
I've heard a lot of, you know,
it's a challenge in
current days to attract,
you know, new people into this
field of laboratory medicine.
Do you think that there's,
do you have thoughts for
how we might approach this,
you know, as a healthcare
system of attracting,
you know, bright students into
medical laboratory science?
- I often use the analogy that
we're like the Wizard of Oz.
We're the man behind, the man
and woman behind the curtain
and everything turns to gold, right?
But they never know
who's behind the curtain.
That's the lab.
They never see us.
And if there's anything we need to do,
we have to figure out how to really erase
some of our invisibility that we have.
Getting ourselves more visible is really,
probably the most important thing.
And that means visible not
only to future employees
and students or colleges, but
also in our own institution.
You know, I don't know if
you've noticed here at Mayo,
Justin, but over the last year or so,
we have been really successful
at putting out laboratory
studies into our weekly,
you know, the Mayo newsletter
that comes out on Friday,
you know, electronic, you know,
but whatever it's called Mayo
This Week, or whatever it is,
look at how many lab
stories are showing up
in that thing every week.
I have heard so many people
from non-laboratory areas say,
"wow, the laboratory
is really impressive!"
So I think we really need
to figure out collectively
as a, certainly as a profession,
but also at the local level,
how can we make ourselves
more visible locally?
And then I think that
by itself will help land
to that next step.
If we get used to being
more visible locally
within our own organizations,
we can become more visible into those,
you know, whether it be
educational areas and locations
or other just in general
within the community.
I think visibility is obviously the key
and we go into it with one
hand tied behind our back
because we do things so well and we do it
in such an invisible way.
We just get asked and we do things.
- Mm hmm, and what I hear
too in your answer is,
you know, with visibility,
it's not just a one
and done sort of thing,
but your answer kind of
talking about, you know,
how many of these stories have made it
into Mayo This Week, right?
So it's not just showing this once,
but we're continuing
to share these stories
so that our community continues to see,
and to use your words,
erase the invisibility of the laboratory.
- Absolutely.
Really critical.
You know, and this is a
challenge all across medicine.
It's not just the laboratory.
You know, and COVID obviously
has done nobody any favors
in so many ways, but, you know,
I think healthcare in
general is running into
how do you get enough of the right people,
enough of the right dedicated people
with the right, you know, mission focus,
to walk into the jobs that we really need
here in healthcare.
So it's not just labs.
I mean, obviously we're very parochial
in thinking about the labs,
but it really extends
across all of healthcare.
- To flip this in another direction,
I just wanna kinda close out
maybe this podcast and ask you,
you know, certainly as
we're celebrating lab week
with this podcast episode, you know,
there might be something that, you know,
certainly we can celebrate it.
You know, we've done our work,
but is there something that we've done
that maybe we shouldn't
continue that we need to change
and kind of discontinue a certain process
or way that laboratory works?
- Well, I think we should immediately stop
pipetting by mouth.
I think that needs to
stop immediately. (laughs)
- You're spreading fake news now.
- No, no, that is not
happening at Mayo Clinic.
You're right.
I gotta be sure about that.
Actually it was still going,
when I started, it was optional
in a couple of laboratories,
because of the nature of their specimens
and then obviously AIDS
emerged in the mid eighties
and all of a sudden, a lot more knowledge
about hepatitis came
about and it just stopped.
Thank God.
It's really an interesting question.
I don't quite know how to answer it.
I guess, I wish I had
some big overarching philosophical thing
I could throw at you,
Justin, but I really can't.
The thing that probably
comes to my mind is
I think we're of the,
we're clearly a
service-oriented profession.
We're asked and we give.
You know, a lot of times we have the
any test, any time,
any way you want to it,
we'll give it to you.
And I think we really need to,
in this era of increasingly
limited dollars for healthcare,
not an unlimited supply of people,
we have to start asking the question of,
let's use our knowledge
and expertise to say,
let's be sure we're doing the right tests
for the right reason.
And I think as you look at the horizon
and you see the increasing emergence
of artificial intelligence
or augmented intelligence,
depending on what you call it,
it's really gonna lend itself
to really asking those
kind of questions of,
let's be sure we're doing
the right for our patients,
whether it's under testing
or over testing, either one.
I think that needs to be the,
we need to move from that
mindset of any test, any time,
to really, let's be sure
we're doing the right test
and not the one that you want,
and don't forget about doing this test,
because this is the one you really need.
So I think that mentality.
The mentality of that, the
mentality of visibility,
if there were any two things
that I'd like to see us,
if I look back in 10 years
as I sit in my rocking chair,
I really hope that's what
I see in our profession.
- Yeah.
You really have tied
this together quite well
with that thought, right?
'Cause certainly, that's
critically examining,
you know, what's our way
and what's our practice,
and, you know, certainly
by making us, you know,
how do we shift from service orientation
to really being colleagues,
you know, equals
with our other, you know,
healthcare professionals,
that's really going to one, help us
to be able to advocate for
best laboratory practice
to support the clinical practice,
but also certainly make
us more visible as well.
- I'm full of editorials
at this time of my career.
And one of the things,
I don't remember if I told you this
when you wrote rotated
through once upon a time,
but I typically tell my
residents when I rotate through
is "you are a clinician.
You're every bit as much of a clinician
as any of our colleagues that we work with
across the street.
Never forget that."
It's really important, because
I think we need to look at
now, I'm not talking about,
I'm moving beyond the
technologists in the laboratories
to folks at our level.
We need to always think of ourselves
that we are every bit is
involved with and responsible for
and take and care of our patients.
And I think that's an important mindset.
A lot of these things are the mindsets,
I think, that we need to really work on
as a profession, Justin,
as I look at this.
- Excellent.
We've been rounding with Dr. Curt Hanson.
Thank you so much for taking
the time to talk about this
and celebrate lab week with our listeners.
- It's been great.
What a great time.
I can check off my bucket list,
I've had an interview
with the Bow Tie Bandit.
This is fabulous.
- That's right!
And to all of our listeners,
thank you for joining us today.
We invite you to share your
thoughts and suggestions
via email.
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Please direct any suggestions
to mcleducation@mayo.edu
and reference this podcast.
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