Speaker 1 (00:07):
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. Lab week is almost here, and we thought it would be fun to sit down with someone who has worn many hats throughout her laboratory career and celebrate it's past as we look into the future. Joining us today is Jane Hermanson, manager of Mayo Clinic Laboratories Outreach and Network Development team. Thanks for joining us today, Jane.
Speaker 2 (00:43):
Thank you so much. It's great to be here. And I will say when anyone says, I want to talk about the past, does that mean I'm actually old? But I'm going to say nope, not old, I just have a ton of experience and I'm delighted to talk about the past and really what the future will bring for us. Thank you.
Speaker 1 (01:00):
Ah, it's gonna be awesome. In the beginning you were telling us about the pearls that you used to wear in the laboratory, and you're gonna have wonderful pearls for our audience today. Let's kick it off from your perspective, you know, keep in mind, you've got this role of development and such. Why is it important to look at the past when planning for the future, this theme of lab week?
Speaker 2 (01:21):
You know, that's a really good question. And I think it really comes down to, if you don't understand where you came from, you'll never be able to know where you're going, right? And we have of course, historical trends that have happened in industry. And I've been around long enough that I've seen the pendulum swing. So sometimes we go this way and then we go back the other way. And then we come back again and normalize. And with each of those swings comes a lot of change, but we always normalize and we always come back to center. And for me, the reason I got into laboratory medicine in the first place is because of the patient. So I was a scientist, but I knew that I didn't want to work in a chemical manufacturing plant making shampoo. I wanted to make a difference, so I joined health care for that reason.
Speaker 2 (02:06):
I think that when it comes to planning for the future, you need to look at the past, see where we've been, what worked, and especially when it comes to projecting future volumes, projecting your budget, things like that, just from a leadership perspective, the past is always going to be your very best baseline line, but you also need to make sure that you're learning from some of the disruption. So as an example, in the mid 1990s, there was a big trend toward total lab automation. And I worked in a laboratory that had some automation, but not a ton. And we went, oh my gosh, total lab automation, robots are gonna take over our jobs. What am I gonna do for a living? Oh my gosh. I was really worried that I wouldn't have a job to do. Well, here we are 25 years into the future and we don't have enough people to do the work.
Speaker 2 (02:56):
Thank goodness we had that automation and that disruptor. So disruption doesn't always mean something bad is happening. Take that disruptor and actually use it to your advantage. I think the other thing is to learn lessons. And when you think about applying some of these disruptors and I'll just stay on the line of laboratory automation, if you automate a bad process, you have gained nothing. So learn some lessons from some of the, maybe the mistakes that you've made, learn lessons from the work that you're doing today and evolve that. And then once you've got it evolved, leaned out and as efficient as you can, then you automate it and then you're going to realize further efficiencies. So I think learning lessons is incredibly important to looking to the past and then applying those lessons to the future. And then lastly, keeping an eye on industry trends because things are changing today.
Speaker 2 (03:53):
We're looking at new payment models, new ways to use laboratory medicine and new trends just in caring for our populations. And the fact that laboratory has gotten so much attention due to the pandemic, this is our golden moment. If we don't say the world revolves around lab, shame on us, because it does. Providers can't do it without us, doctors without us, they're only guessing, right. They need the information that we can provide. So for us, if we can actually keep an eye on the industry trends and make sure that we have a relevant spot at the table, our future's going to continue to be bright.
Speaker 1 (04:30):
Yeah. I'm hearing echoes from, we had, Dr. Maurice on the podcast recently talking about some of the challenges that we face and, you know specifically around health care equity and how we can support this as a laboratory. And I'm curious, you know, keeping in mind our audience, we've got laboratorians, we've got pathologists, we have other physicians from the health care team listening, what might be a good resource, or what would you recommend to be aware of these larger trends? Cause sometimes I think we all get so busy and buried in our work and we kind of get those blinders on. Obviously you have kept your fingers on the pulse of the industry. What do you recommend people listen to or look at?
Speaker 2 (05:15):
I get asked this actually quite a bit and what I've finally ended up doing was creating a little list of the websites that I frequent and the email distributions that I sign up for because there's a ton of information out there and it really comes down to us to really weed it out and say, okay, what's most relevant. And for people who don't want to go through the effort of reading all of these emails, I would say that your professional associations are a tremendous source of resources for you. So if you consider ASCP, or for me, something that was really a key for me in my leadership path was the Clinical Lab Management Association, which is now part of ASCP, but also looking to the scientific professional associations, AABB, AECC, you know, you can pick your alphabets, right?
Speaker 2 (06:01):
But if you look at each of those professional associations, they have people who are looking at those industry trends, and they're going to be bringing those in a messaging that's relevant to the memberships. Also just paying attention to what our own department leaders are saying through Mayo Clinic and through other organizations, your own organization is going to have an idea of what is strategic and important for you and your community. And the way that health care is practiced in central Iowa is going to be very different from how health care is practiced in metropolitan New York City. So making sure that you're paying attention to those local trends as well. So ton of resources, I would say that my preferred source really comes through our trade associations, the industry associations that we're affiliated with, because they're going to bring me relevant content.
Speaker 1 (06:50):
That's wonderful. Thank you for that. Getting back to lab week and celebrating it. I'm kind of curious, what are one or two aspects of pathology and laboratory medicines past that you are interested in celebrating this lab week?
Speaker 2 (07:07):
Wow. I think the main thing to celebrate is that I, I believe, and I will formally announce it on this podcast, I think we're maybe done with the pandemic, we're coming out of it. So we should celebrate, we have survived and we have the scars to show for it, but we have survived. And we really, as an industry did our best to keep our nation healthy. And we are continuing to now evolve based on those learning lessons, so that we're ready for the next time we have a public health emergency and we also have this fantastic opportunity, that's come now because we have new equipment, new technology, and a larger knowledge of how we can apply that technology in the public. So I think that we need to number one, celebrate the fact that we are moving away from the pandemic and looking to a super bright future.
Speaker 2 (07:58):
But the other thing I think is just to consider other milestone aspects, and I just realized that this year ASCP, which is our certifying agency for many of the laboratory professionals that are listening, whether they're pathologists or at the bench level, a lot of our professionals, ASCP is celebrating 100 years. A hundred years as a profession, I think is really important. And something that I became aware of a few years ago was just the definition of the word profession. And it's not a job. A profession is considered more of a calling. It's a special type of work where you are providing a service, you're bringing some thing of yourself. So it's not saying that being a laboratory professional is a job because it's not, it is a calling. So it was acknowledged a hundred years ago and we've continued to survive and really thrive as a result of being supported.
Speaker 1 (08:58):
I'm glad you're calling attention to profession here. Cause I think, this also kind of speaks to, we had a previous podcast with Dr. Bellamkonda, about wellbeing and wellness. And again, this idea that through the pandemic, there's been a lot of challenges in the laboratory and a lot of work that's been done under extreme time pressures. And you're right on the money to kind of pull us back, a little bit and just to reflect on wow, 100 years as a profession, we've been recognized. Taking that reflective point on that, what do you think then, how do we kind of launch this into the future? How do we use this professional past, and maybe these experiences with the pandemic you've been talking about knowing where we've been to inform where we're going and, learning from this, how do you see this informing this future success?
Speaker 2 (09:53):
I think we really have a great opportunity today. And I think about the original silos that were created, we had pathology, so there was anatomic pathology, and that was a very specific discipline and very defined roles and very defined outcomes. So you had a piece of tissue, you looked in the microscope, you created a diagnosis and that was it. And then we had clinical laboratories. If it was a wet specimen, you put it on a piece of equipment. You looked in the microscope to look at the cells, and that was the outcome. And today what we're seeing is so much more coordination between clinical anatomic and we're having consolidated reports. We're now tying genomics and the lines have become very fuzzy. So I think for us to look to the future, it's not pathology and clinical laboratory, but we as an industry really need to look at providing medical laboratory diagnostics, whether it is happening through a pathologists eye or through the laboratory scientists eye, we're really creating a diagnosis together. So I think that breaking down the barriers between the different disciplines and just moving forward with an eye toward providing the best care and the best outcome for the patient is where we need to make sure that as we plan for the future, that we have that ultimate goal.
Speaker 3 (11:19):
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Speaker 1 (11:34):
Silos is a challenge that I hear from a lot of colleagues. I've heard this for years. And sometimes people, you know, kind of bemoan, you know, when you say it's silo. It almost sounds like it's a given and it's some fact of life that cannot be altered. Is there a favorite example in history you can think of in laboratory medicine, pathology, our community we've been successful at crossing these silos, some example that might give us inspiration for the future as we kind of go towards more of this coordination among each other?
Speaker 2 (12:13):
So I think that if you just look at the, and you physicians can speak to this much better than I can, but I think just managing a leukemia or a lymphoma diagnosis is certainly a perfect example. So I'll use lymphoma as an example. So you need to have your liver enzymes that you're, you're testing on the patient. You go, oh, there's and going on. And then you go into looking at a blood count and now you can see abnormal cells. And then you're going to follow up with a bone marrow and you see, you have the morphology, but then flo cytometry is actually going to tell you what kind of cells you have. And all of a sudden, then you've got the lymph node biopsy and you put this whole picture together. And it started with the symptom and an abnormal liver enzyme, but all of those pieces as a whole create that picture.
Speaker 2 (13:01):
And it's not only just to come up with the diagnosis, but based on the markers that you've identified through the genetic testing and through the flocytometry, now you're going to be able to choose the best treatment for that patient, right? So instead of wasting time, money, and really making your patient more ill through chemotherapy, you're going to be able to target that treatment. We had a family member where this is exactly the path that they took, and we had no idea that it was leading to a lymphoma diagnosis, subsequent treatment, and, extended life as a result of it. But knowing that they couldn't have done any of those things without laboratory is fantastic. So if we say, okay, we learned this cross discipline. It, wasn't only a clinical piece. It wasn't only an anatomic piece, it's coordinated. How else do we apply that?
Speaker 2 (13:53):
It works very, very well in the areas of hematology, oncology, but are there other ways that we can do this? And I think we're getting there. If you look some at some of the work that the national kidney foundation is doing, for example, related to chronic kidney disease, acute kidney injury, and they're working on coordinating the diagnostic tools through the different aspects of care delivery, we have a lot of opportunities, and it's not just dealing with an oncology diagnosis. Now we're moving into treating or preventing chronic illness and really mitigating the long term impact on the cost of health care for our country.
Speaker 1 (14:31):
You know, the way you are talking, just there reminds me of a lot of times, I describe the work I do, as, you know, if you're gonna be marooned on a desert island, I'm not the kind of person I'm gonna be that useful to you, but if you wanna practice the most sophisticated medicine, we are essential for that. And I think your example of talking about the lymphoma diagnosis and how that workup is, I think that's a wonderful example for this kind of back to the future theme of lab week, right? Where there actually has been a pretty long tradition of this coordination and collaboration that has happened and even more or so recently for the newer diagnostics that are helping to drive therapeutics in a much more pinpoint way. I kinda wanted to ask you, you know, from your vantage point and perspective, what do you wish for the future of laboratory medicine and pathology?
Speaker 2 (15:29):
That's a really good question and what I would say is it's really interesting, because I think about my own past, and when I graduated from college, there were no jobs. There were no med tech jobs available in the area. And why was that? It was because it was the mid eighties. And they had just implemented the first wave of DRGs and Medicare reimbursement went to bundled payments instead of fee for service. And hospitals went, oh my gosh, we have to change the way we do work. And they cut a lot of laboratory positions. I literally sent out over 100 applications for jobs in the state and got two offers. One was at a large metropolitan hospital, and I would've been working the night shift in a rapid response lab. And the other was in a small rural community hospital on the Canadian border of Minnesota. It was a remote place.
Speaker 2 (16:23):
And I looked at it and I said, okay, two options. I have just gone through my whole med tech training. And I've learned everything. I could work in a rapid response lab on the night shift and do one thing or two things all the time. Or I can go to this frontier and really be involved and do everything. So I chose the generalist aspect. So I worked in this small hospital for three years. I was on call around the clock. I was drawing blood. I was doing blood gasses. I was drawing blood donors. I was running units of blood down the hall. I did it all. And it was hand to hand combat medicine. But what I learned is that through drawing blood from a patient, I saw what acute pancreatitis looked like. And then I could see that laboratory test. I could see the amylase result.
Speaker 2 (17:14):
I could see their white cells. I knew exactly what the laboratory picture was. And I had the opportunity to tie that picture together. I think that as we, as professionals become more removed from the patient bedside, we don't have that insight into the patient. We don't have the empathy of seeing what that patient is going through. So going forward, looking to the future, I hope that we as professionals never lose touch with the reason we're in laboratory medicine in the first place. To me, it really made all the difference to have that patient aspect. And it has really informed and truly created the professional that I am today, because I did have that in the trenches experience. And without it, I don't think that I'd be as effective as I am today. So that's one piece to not let go of the patient piece. And if you have an opportunity to be in a more generalist position and then tie the picture of the diagnostics back to that patient, it actually is going to help you feel like you're adding more value.
Speaker 1 (18:23):
I really think that's wonderful. I mean, that's one of the main reasons I went into transfusion medicine as a specialist, was the opportunity to be at the bedside with the patient, was sort of ingrained in the practice, but also your comments about working as a generalist, you know, my first seven years or so in practice, I worked as a general pathologist over a small general lab that actually did a lot of work. It was a smaller reference lab, but it was really wonderful to have chemistry things come up, have infectious disease stuff come up, have micro, have transfusion. It's really a lot of fun I think though, the full gambit of lab medicine.
Speaker 2 (19:05):
I think that we as professionals, each of us, whether you're a pathologist, phlebotomist, or a laboratory scientist, I think we each need to be able to promote and advocate for our profession. And when we look at our staffing shortage today, we need to make sure that we are promoting the profession to those emerging scientists. So you can actually find kids in high school to say, you know what, if you like patient care, but you don't wanna be a nurse. How about being a laboratory scientist? And for me, why did I choose to be a medical laboratory professional? Well, I'm going to blame my uncle because when I was eight years old, my uncle who was a lab scientist, he took me into his hospital laboratory. I was visiting him for the weekend. He got called in and he said, Janie, why don't you come with me?
Speaker 2 (19:52):
I have to do a little bit of work, but you can just sit here and I'll give you some stuff to keep you busy while I'm doing my work. So he set me up at a benchtop in his hospital laboratory, and I had the opportunity with a bunch of tubes to take a little eye drop and drop stuff into these tubes. And the tubes changed color. That was really cool. Well, what I was doing was a manual bilirubin. So I'd put this yellow stuff in and the tube would turn pink. And I thought that was really cool. And guess what? The more yellow I put in the pinker, it got, I was having this visual re reward and I went, this is actually kinda cool. So I said, okay, well, how do I do this? When I grow up, I want to do more of this.
Speaker 2 (20:32):
So that is really the reason I got interested in laboratory medicine. Now, of course, no, you're not gonna be taking kids into the lab and playing with manual bilirubin today. But how do we actually make the field appealing? How do we help others understand that this is an option? It is a career that's available for people. So my life was changed forever. Truly when I was eight, I went, I wanna do this when I grow up and I never changed path. And even when I was in college, he'd call me up. He'd said, Jane, it's not too late to switch your major. You don't have to do this and I'm going, yeah, but I want to, this is where I belong. For me, I've never regretted that choice. And my hope for the future of our industry and our profession as laboratory professionals, that we are able to advocate for the profession, bring more people in to our programs so that they can actually bring that same joy to the work that we do everyday. And then it's not just about the profession. It really comes down to the fact that we are there for the patients and the work that we do helps provide and improve great patient care, improving the outcomes, and they can't do it without laboratory medicine and pathology.
Speaker 1 (21:45):
Sounds like you really had an, an impactful experience in your first introduction to laboratory medicine. And I hear that challenge of this is more than just pamphlets being distributed at college campuses or in high schools. That that experience was really formative. And then also it sounds like your first work in the field was also very formative as well. And very intentional. That's this sort of experience here. It's been wonderful to have this experience with you and to be round you with you, Jane.
Speaker 2 (22:24):
You bets my pleasure. This has been a lot of fun, and I could tell stories for a really long time, but my best stories always begin with when I worked in International Falls. If you hear one of those stories that begins that way, there's gonna be a pretty exciting drama that comes from it. I would never take any of those moments back, but I also think that the future is incredibly bright for the industry and during medical laboratory professionals week, this is the time to celebrate who we are, what we've done and make sure that we are continuing our mission in the future. It's a pleasure to be here today.
Speaker 1 (22:58):
We've been rounding with Jane Hermansen and, happy lab week 2022 to all of our listeners. Thank you for joining us today. We invite you to share your thoughts and questions via email. Please direct any suggestions to mcleducation@mayo.edu, and reference this podcast. If you've enjoyed Lab Medicine Rounds podcast, please subscribe, until our next rounds together. We encourage you to continue to connect lab medicine and the clinical practice, patient care, through insightful conversations.