Peer-to-Peer, Featuring Jeffrey Myers

Jeffrey Myers is the A. James French Professor of Diagnostic Pathology and Vice Chair for Clinical Affairs and Quality in Michigan Medicine’s Department of Pathology at the University of Michigan. He also serves as Director of MLabs, the institution’s reference laboratory division. A general surgical pathologist, he is increasingly focused on his subspecialty interest in thoracic pathology, but also has a longstanding commitment to quality and safety, accompanied by a more recent focus on patient- and family-centered care.

His career has given him plenty to think about, and the many people he has had the privilege of mentoring or being mentored by have taught him valuable lessons. Now, in an interview with professional colleague Ivan Damjanov, Jeffrey Myers shares what he has learned to benefit his colleagues in the pathology sphere.

You wear many professional hats. Which duties take up most of your time, and which bring you the most pleasure?

My role as Vice Chair for Clinical Affairs and Quality consumes more of my time than anything else listed on my CV. To some extent, that reflects increased demand over the last couple of years, largely related to a move of our non-stat clinical operations to a new site about three miles away from the main medical campus. We designed and built a facility that reflects the future of our discipline: laboratories designed using Lean principles and tools, paired with non-laboratory space designed to facilitate collaboration and creativity in a digital age. The spaces are partially divided by the increasingly parochial interests peculiar to subspecialization. Although we got many things right, we have also encountered unanticipated challenges. Even those aren’t all bad news, though; they offer an endless string of opportunities for continuous improvement.

It is still hard to beat signing out as the thing that gives me the most pleasure. This has only gotten better since the launch of our pathology-based Patient and Family Advisory Council (PFAC), which has given me back a sense of purpose. More than anything else I do, signing out helps connect me to the reason I went into pathology in the first place: tending to the welfare of those who look to us for answers and hope.

Is that what you always wanted?

I have never been clear enough about my future to identify anything in particular that I “always wanted.” My undergraduate inspirations for wanting to do pathology in the first place, Jack Spier and Les Torgerson, modeled what it meant to be a “doctor’s doctor” and touch the lives of countless patients every day. Those are the things to which I aspired when I redirected my career away from social work toward medicine.

Anna-Luise Katzenstein – my lifelong mentor, collaborator and friend – showed me what it meant to be true to the work, curious about everything, and dedicated to fair and equitable conduct in all things. When I finished medical school, those things became my aspirations – and it’s hard to think of a better place in which to practice those things than the Mayo Clinic, where I spent 16 wonderful years learning from colleagues who “walked the walk” when it comes to excellence in clinical care.

I came to the University of Michigan to understand opportunities unique to a larger university setting, and to explore a powerful combination: a highly functioning clinical enterprise resting on a foundation of world-class research and a legacy of educational excellence. I was the beneficiary of a whole new set of mentors and colleagues in multiple departments and schools, with new opportunities to explore different approaches to quality and patient- and family-centered care.

The care of patients has always been, and always will be, my chief priority – it is my “non-negotiable.” Any other priorities evolved organically and were driven by challenges and opportunities to serve the pathology community through member organizations, mentor trainees and peers, and learn through collaborative, clinically focused science. I followed my passions with nothing resembling a career development plan, focusing on doing the right things for the right reasons and walking through doors when they opened.

What are the most important changes you have introduced in your department?

Changes that might qualify as novel and innovative over the last 13 years here in Ann Arbor include:

• a unique frozen section practice to support breast cancer patients in an ambulatory setting;
• an integrated center of excellence in forensic medicine that combines the strengths of our university-based autopsy practice and regional medical examiner (ME) offices, including Wayne County in Detroit;
• the design of the non-laboratory space into which we recently moved, focusing on collaboration and creativity across subspecialty silos;
• creating a Division of Quality and Health Improvement to increase our capacity for value creation from a laboratory platform; and
• launching a pathology-based PFAC to nurture a culture of patient- and family-centered diagnostic medicine in our department, our health care system, and our discipline.

Unfortunately, I remain frustrated at my inability to advance standardization of practice supported by tools to motivate individual practitioners. We still have work to do when it comes to achieving essential levels of consistency; only in that way can we, as a foundational element of diagnostic medicine, become as cost-effective and efficient as we should – and could – be. We cling to increasingly anachronistic paradigms that may have been more relevant in a volume-based healthcare ecosystem. We must learn to do better; our goal should be to optimize patient care, and that means being accountable for the choices we make when it comes to resource utilization.

Which of your many papers are your personal favorites?

I loved working with Anna-Luise Katzenstein for all sorts of reasons, chief among them her very clear and logical thinking, her deep understanding of both the problems and the solutions, and her discipline when it came to translating the work into a manuscript. I was especially proud of the work we did in the 1980s using electron microscopy to advance our understanding of fibrotic lung diseases as models of abnormal wound healing. This work included a case report that defined fibroblast foci as sentinel clues to the pathogenesis of lung fibrosis (1) and a study of organizing pneumonia that identified features common to other forms of acute lung injury (2).

In a larger sense, I am not sure that I’d say I have done anything to advance either the practice or theory of pathology. If I have, it was to embrace the privilege of training others who have collectively done far more to advance both.

How did you approach the task of making an excellent pathology textbook even better?

The task of editing the new edition of Rosai and Ackerman’s Surgical Pathology was intimidating; it felt like there was no way to make it better. At first, I thought that the best we could hope for was to avoid making it less than it already was! My fellow editors and I were determined to preserve the voice unique to a single-author textbook while acknowledging that no human being other than Juan Rosai himself could possibly accomplish this task in the same way that he did. We did the best we could to maintain his voice; at the same time, we updated information and images to serve the needs of an international community for whom the world has changed, impacted by a march toward subspecialization and the application of increasingly sophisticated diagnostic tools. For me as an editor and author, it meant often leaving something in place that I might have been tempted to say a little differently, or deciding to leave a photomicrograph rather than replace it with one of my own. I told myself it was foolish to imagine that I could possibly say better, or more effectively convey in images, what I could never understand in the same way that he does.

What else are you working on?

In 2011, I went to a Jeff Beck concert with my friend and colleague, Joel Greenson. It reawakened in me an interest in playing rock ’n’ roll which is something I had given up nearly 40 years before. We joined forces with our colleague, Ulysses Balis, and some very talented local musicians to form a band called Lost in Processing. Organizations like the American Society of Clinical Pathology and the Texas and California Societies of Pathology have been generous in offering us opportunities to perform and we are having a blast! The problem is that there are not enough hours in the day or week to make the sort of musical progress that I would like to make, especially given an advancing tremor that makes some once-easy things harder. I would love to see our dreams come true for this band while we still can! That will mean figuring out ways to work more intensely to bridge the gap between my skills and those necessary to make the sort of music that others may want to hear – but I have faith that we can do it.