Monthly Archives: January 2017

“The Micro-meeting”

I attend two or three meetings a week, related to laboratory management, infection control or antimicrobial stewardship.

I am a strong believer in the philosophy that the productivity of the meeting (in terms of making decisions and getting things done) is  inversely proportional to the size of the meeting group or committee.

“A meeting of two people is optimal, four is acceptable, six is just tolerable, more than six and it becomes a bureaucratic nightmare. Too many people having an opinion, and the goal of consensus becomes a pipe dream.”

Simply put, I prefer “micro-meetings”.  For large group meetings, I strongly recommend the formation of an “executive committee” so that decisions can be taken and outcomes effected.

Here are a few of my other thoughts and observations on meetings over the years. I actually don’t mind (most) meetings, and I enjoy the social and anthropological side to them…

  • Keep smartphones out: I have occasionally been guilty myself of using smartphones during meetings, but less and less so now. At best it is distracting, at worst it is rude and disrespectful to your colleagues. Leave your phone in your pocket, or even better give it to someone who can take messages for you. There is very little in laboratory practice (or Facebook) that cannot wait for an hour.
  • Contribute: There is very little point in going to a meeting if you don’t contribute, best not to go at all. If you feel you have nothing to contribute, then you are in the wrong meeting, or possibly even the wrong job.
  • Don’t dither: “Parking” items just delays a decision from being made. You need to have a very good reason for deferring a decision on an agenda item. Just make a decision, in the appreciation that it might not always be the right one. Deferring just prolongs the agony. A good chair is essential for this point.
  • Keep it short: My concentration span is only 1 hour, so any meeting that goes beyond this I tend to struggle with. Also, don’t feel obliged to stay glued to your seat for the whole hour. Get up, wander, have a coffee, whatever…
  • Keep to the agenda: When it’s finished, it’s finished. For example (and you will relate to this), the meeting is scheduled from 3-4pm. However you finish the agenda items by 3.30pm and then fill the remaining half hour up with small talk, gossip and meandering discussions. Don’t… When the agenda is complete, get the hell out of there! And never include “AOB” as an agenda item. That is just inviting trouble.
  • Avoid teleconferences: I have a personal phobia of teleconferences. I avoid them wherever possible. Telephones were designed for one to one interactions, but are simply awful when applied to groups. Videoconferencing is marginally better but still falls well short of face to face.

Meetings are of course “A Unilateralist’s Curse” . Nevertheless, it is my belief that in order for a policy to be implemented successfully, you do need a critical threshold of colleagues to support it.

Meetings are essentially all about persuasion…

Michael

“Something for the weekend?”

I know it is difficult to believe, but patients tend to be just as sick on Saturday and Sunday as they are from Monday to Friday.

I am not sure if the concept of the “weekend” is secondary to religion or the industrial revolution. Regardless of its origins, in healthcare facilities throughout the world, the clinical service that is provided at the end of the week is reduced somewhat. Weekends are good for society, but not so good for patients…

And the weekend is not always just two days. Add on a Public Holiday Monday and the weekend can stretch to three days. Over Christmas, New Year and Easter, the “weekend” is often four days. Four days is a long time if you are sick.

In clinical microbiology laboratories everywhere, molecular testing traditionally never happened at the weekend. The molecular department happily shut up shop on Friday afternoon, and re-opened again on Monday morning. In times gone by, this was due to the rather specialised nature of the testing, and also the relatively slow turnaround times.

Take the following hypothetical scenario, which you may be familiar with…

It is the evening before the Christmas break. A cerebrospinal fluid (CSF) sample comes in to the microbiology laboratory from a patient in ICU with meningoencephalitis. A viral PCR panel is requested to try and ascertain the cause of the patient’s symptoms. However because it is the weekend coming up, followed by two public holidays, it will be 5 (long) days before the PCR is performed.

A viral CSF PCR result can have the following positive effects on patient management:

  • A negative (HSV) result can allow empirical therapies such as acyclovir to be discontinued, or in the case of a positive result, the dose to be optimised.
  • A positive result can prevent further investigations, such as MRI scanning, and  other “exotic” laboratory tests being carried out on the CSF.
  • Can expedite discharge, when diagnosis is known.

The long weekend progresses, and the microbiology department continues to analyse significant volumes of relatively low value specimens. e.g. ear swabs, peri-anal abscess swabs, vaginal swabs, swabs from leg ulcers etc, etc. Yet sitting there patiently in the fridge is that CSF, probably the most important sample in the laboratory, and the one which could have the most immediate and profound effect on patient management. It looks on enviously at all the attention the other samples in the laboratory are getting!

This model doesn’t really cut the mustard anymore… We need to utilise the new (user friendly and rapid turnaround) molecular platforms (Cepheid Genexpert, BD Max as examples), so that we can offer a laboratory service at the weekend which has a genuine clinical impact.

Things are changing however. Molecular testing is slowly being introduced at the weekend in many microbiology laboratories. C. difficile testing and Influenza/RSV PCR are a couple of examples. But this progress takes time, and sometimes it takes more time than it should do.

We need to “disrupt” traditional weekend work at the clinical microbiology laboratory… On the weekend, put those ear and vaginal swabs back in the fridge, and find a way (somehow) to take the CSF out!

Michael

Remember “The Purple Cow Giveaway” for new subscribers. 5 new subscribers so far in the draw for 5 books, so the odds of winning are quite good! 4 days left.

“The Purple Cow Giveaway”

All new subscribers this week to the webpage www.microbiologymatters.com will go into a random draw to win one of five copies of my book “The Art of Clinical Microbiology“.

At the end of the week (15th January 2017), I will email the 5 winners to get the delivery addresses (which will obviously be free as well, wherever in the world you are!).

Clinical microbiology is a niche area, so I very much rely on word of mouth to advertise the website. Please share this with your friends and colleagues. Many thanks!

Good luck!

Michael

p.s. I had a look at the website stats for last year (I like stats…), and here are the top 10 most popular (by visitor clicks) posts from 2016. They are all hyperlinked.

  1. “Why you should not buy a microbiology textbook”
  2. “The dark art of overnight incubation”
  3. “Too much knowledge”
  4. “Selling your soul to the devil”
  5. “The digital microbiologist”
  6. “The rock star microbiologist”
  7. “The need for speed”
  8. “Tricky Trichomonas”
  9. “The Trade-off”
  10. “The blind microbiologist”