Compatible Careers: A Laboratorian’s Journey
How a background in laboratory science led me to a career in pathology
Constantine Kanakis | | Longer Read
Those who come from a laboratory background have a unique insight into pathology, and a grounding in laboratory science can offer medical students a head start. Laboratory experience can also encourage those without previous exposure to pathology to consider it as a discipline. No matter your role in the laboratory, it’s vital to remember that behind each sample is a human being.
If you’re reading this, you’re almost certain to have a vested interest in the field of pathology and laboratory medicine. Maybe you’re a pathologist yourself – or perhaps an educator, student, or clinical technologist? Each of these roles plays a critical part in our profession – trust me, I’ve been through most of them! My personal and professional experience is somewhat unusual, although I do know of others who have followed a similar path to pathology. I’m definitely not the only one who graduated from the bench to the bedside, but I do think having done so gives one a unique perspective.
After attending the 2019 ASCP Annual Meeting and reading Austin McHenry and Kamran Mirza’s piece “The Case for a Universal Clerkship” (1) in The Pathologist, I sense a culture shift that is drawing the spotlight onto the amazing opportunities that exist within our field. However, without my history as a medical laboratory scientist, this information would have floated right past me – unnoticed! Medical students are often advised to join professional societies or interest groups in the specialty areas that catch their attention. They tend to agglutinate around surgery, family medicine, pediatrics, emergency… the usual suspects. These fields are great – and critical to the practice of clinical medicine – but pathology often falls by the wayside in lieu of other, more dynamic, and more visible specialties. I had the distinct privilege of gaining exposure to laboratory medicine during my undergraduate education at Loyola University Chicago and since then have encountered innumerable examples that reaffirmed my passion for pathology.
From lab work to lab-at-work
During university, I studied several subjects that culminated in a bachelor’s degree in biology with a molecular emphasis (and minors in bioethics and political science – I had varied interests!). About halfway through my studies, I got a job in the Rush University Medical Center blood bank as an expediter – a fancy title for the lab technician who receives and enters specimens, takes phone calls, and dispenses blood and blood products under appropriate quality guidelines. I remember the interview; my first time walking through a clinical lab was intimidating, but also exciting. Most blood bankers reading this will know that such a lab can move quickly, and it did. I became a professional in FDA reportable guidelines, quality assurance and monitoring, and standard operating procedures. Every day I went to work, I learned something new about clinical care and about laboratory medicine at large. Like the majority of biology degree holders, I had wanted to apply to medical school even before my laboratory job – but now, something else was starting to shine through.
The more I learned, the more professions in the allied health category came out from behind the scenes. There was a donor center attached to my blood bank at the time, so I met various specialists – respiratory therapists, occupational therapists, and more – each teaching me that the “physician” was part of a large array of devoted clinicians who all held crucial roles in patient care. I learned more about the people I worked with each shift: medical technologists (now called medical laboratory scientists) with certifications, degrees, licenses, and endless experience. How that would fit into my medical aspirations I didn’t yet quite understand.
From grad to grad school
After I graduated from university, I made the decision to go to graduate school at Rush – the place where my laboratory learning began. I obtained a Master of Science in Clinical Laboratory Medicine and sat for my Medical Laboratory Science certificate exam shortly thereafter. Graduate school was truly an enlightening experience; I got to learn what my technologist colleagues knew and dive deep into the subspecialized knowledge involved in each laboratory test. The research and teaching I encountered during this course of study also demonstrated pathology’s broad reach in applied translational medicine and in educating our colleagues and peers. I learned a slew of new concepts and skills I hadn’t even heard of during my job in the blood bank. I was getting closer! I knew more about what test results meant, what systems were in place to manage test utilization, how tests impacted clinical decisions, and just how much medicine relies on accurate results!
In the end, I obtained a graduate degree, did some formative research that set up my future interests, became a board-certified medical laboratory scientist, and found two jobs to work after graduating… but something was still missing. My knowledge of clinical practices was growing, but I found myself further from becoming a physician. It seemed I was at a crossroads: jump right back on the academic path toward medical school or stay in the professional world to learn more and climb a bit higher to get a clearer view. Ultimately, I chose to work for a few years before revisiting thoughts of medical school. Why? I was motivated by a strong passion for what I was already doing, and I hoped that a few years of the work I loved would help me find the right niche to move forward in my career pursuits.
Finding a profession as a professional
After grad school, I worked as a medical laboratory scientist generalist at Swedish Covenant Hospital and in the blood bank at Northwestern Memorial. The former was a small community institution; the latter a large Level I Trauma center in downtown Chicago. Both jobs taught me that there’s something to be said about book knowledge versus practical experience – my education prepared me well, but my experiences on the bench at both of those hospitals taught me a great deal in a much shorter time frame. That steep learning curve translated to some great stories and experiences that I’ll never forget and, with each measure of time spent there, I acquired more and more responsibilities.
At Swedish, I contributed to an overhaul and update of their hematology section for an inspection (in fact, I was on the list of various inspection contacts in charge of each department!). At Northwestern, I was given the responsibility of teaching new nurses and clinicians proper blood bank ordering and massive transfusion protocols, as well as managing smaller projects like turnaround time improvement and new employee training. These steps seemed small back then, but they were moves toward graduated responsibility and accountability. They reaffirmed that there was one more challenge I still sought.
I remember a day when a few resident physicians came to look at some peripheral smears in hematology one day when I was working. They came to preview the slide first, asking questions and talking to me about their patients’ cases; later, they were joined by their attending hematology/oncology physician, who came alongside a hematopathologist to continue treatment decision-making. I knew immediately that this was it. This was what I wanted to do!
Laboratory medicine is home
Since then, one experience after another has bolstered my path to pathology. In a whirlwind of events, a colleague nominated me for an American Society for Clinical Pathology (ASCP) award, which I won in the same year as I was named my hospital’s “Lab Scientist of the Year.” I got to attend my first professional society meeting and speak to amazing folks who continue to mentor, shape, and inform my future.
Shortly thereafter, I started medical school, where I used my experiences in leadership to spearhead a public health project aimed at Zika in the Caribbean. I asked one of my mentors how I could share my projects and insights with others, and he connected me with the ASCP’s blog; I’ve now been writing there for nearly three years! My school recognized my contributions with their own awards, as did ASCP, and I even made it to the ASCP’s Top Forty Under 40 list in 2017. Since pursuing medicine, specifically pathology, I have been met with overwhelming support, and I couldn’t be more appreciative.
There are very few medical students who start on day one knowing what specialty they want to pursue – and, of those, I bet even fewer have chosen pathology. Because I had already learned about what tests mean and how results inform decisions, I had a leg up on the first day of medical school. By the time the other students saw their first histology slide, I was already well-equipped to interpret them. I knew how to speak the language of diagnostics: immunology, microbiology, hematology, histology, and more! When it came to understanding how values obtained from patient testing lead to a diagnosis, I was ready – I had already been on the other side of the process. I ran chemistry panels on patients with hepatitis, dispensed HLA-matched platelets to patients with refractory thrombocytopenia, looked at peripheral smears for patients who were suspected to have malaria, and made sure troponin QC was in so the next suspected myocardial infarct was diagnosed on time… all before my first class!
What a unique point of view laboratorians have when changing gears to a career in medicine! I spent nearly a decade working in clinical laboratories; I’ve now spent four years learning how to diagnose and treat; and I am now looking forward to the next few years of dedicated pathology training. Every tube of blood, every biopsy specimen, and every glass slide is a patient – a living, breathing patient waiting for their doctor to talk to them about their results. For those of us who spent time getting those results, it’s an honor to be part of the team that turns critical values into hope.
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- A McHenry, K Mirza, “The Case for a Universal Clerkship”, The Pathologist (2019). Available at: bit.ly/2ljiOz0.