Tag Archives: clinical microbiologist

“Playing the Odds”

The Science of Microbiology, ,

I spent a lot of my medical student days working part-time in the bookmakers, where managing odds and probability underpin the industry. Mathematics was my favourite subject at school, and within that field, probability was my favourite sub-topic.

Now that I am a clinical microbiologist, I can see the similarities. Clinical microbiologists get involved in a lot of the early antimicrobial stewardship decisions for patients based on preliminary/interim microbiology results. This is an area where you definitely need to weigh up the percentages/odds.

For example if you get a positive blood culture with gram positive cocci on the Gram, what will be the probability that this will turn out to be a Staph aureus or even an MRSA? If you are awaiting susceptibilities on an E.coli bacteraemia, what will be the chances it will be an ESBL? These are decisions which have to be made when advising optimal antibiotic therapy. So many factors need to be considered, almost sub-consciously, when calculating these odds.

Of course, with all decisions that involve probability, you will never win (get it right) all of the time. This is where it is critically important to take into account the potential consequences of getting it wrong, i.e. how sick is the patient? how much “reserves” do they have, what level of care are they currently in? In a “game” which involves probabilities, it is careful and prudent management of these probabilities which is key.

The other field of probability that clinical microbiologists must have understanding of are pre- and post- test probability, and positive and negative predictive value. These are key concepts in determining the validity of any test result the laboratory produces.

Playing the odds is an integral part of being a clinical microbiologist. It may even be part of the reason I was attracted to the specialty in the first place. I can even pretend I am still working at the bookies…

Michael

 

“Linchpins and why you should avoid being one”

Confessions of a Microbiologist, ,

For seven (long) years I was the only clinical microbiologist in the laboratory I work in. Most of the important decisions in the laboratory rested on me. This made me feel important, even a little indispensable. I got to call the shots, and pay negotiations were straightforward! For a while I was even reluctant to ask management for assistance because I did not want to share my high level of responsibility.

But such a set-up is never good for the laboratory itself. I was on-call 24/7. When I was on leave, the clinical microbiology service suffered. Although I thought I was making the best management decisions for the patients I could never be sure as I had no peers to obtain feedback on my actions, nobody to bounce ideas off, and most importantly no-one to learn from.

Now I have two consultant colleagues and a registrar in place. I can be away from the lab for days/weeks and normal service will continue quite happily without me. If I am unsure about a microbiological problem (most days), then I can “phone a friend”. I am now part of a team, as opposed to being a linchpin.

New Zealand is a small country with a population of around 5 million people. As such, there are only a small number of clinical microbiologists (around 20). Laboratory services are fragmented with a mixture of public and private providers and there are still some lone clinical microbiologists who are working in relative isolation. We need to create better networks and regional services so we are all working as a team together.

The same principles apply within the microbiology lab itself. It might be a nice feeling to be the only one who can read dermatophyte slopes, the only person who can troubleshoot a molecular testing platform, or the only individual who can perform a particular microscopy stain. But if you are the only one, then it is a terrible position for the lab to be in, and they need to take remedial action to rectify this.

There is no place for linchpins in microbiology, even if our egos might tell us otherwise…

Michael

“The Remote Microbiologist”

Confessions of a Microbiologist, ,

I have been doing some work from home during the New Zealand COVID-19 lockdown period.

With 6 children, 4 cats and a dog at home, this is not always easy! I barricade myself in one of the bedrooms (no office), put a sign on the door (see above), put on some headphones to dull the screams and yells outside, and get down to work…

Clinical microbiologists can do a good proportion of their work remotely. Any work that involves sitting in front of a computer or attending meetings can be done at home with the right equipment. I would say this comprises about 80% of my total workload.

The other 20%, such as reviewing culture plates and Gram stains, familiarisation with new testing platforms, performing AMS ward rounds, infection control ward reviews, and giving educational presentations require me to be either in the lab or hospital. With the digitalisation of culture images (Kiestra TLA) and Gram stains, this percentage may well decrease even further. We do have the Kiestra TLA in our lab, I just need to organise remote viewing…

I think the 80/20 breakdown of remote/in-house work is realistic.

We convince ourselves that we always need to be “present” in the workplace. But for clinical microbiologists this is just not the case. Of course it is nice to talk to and meet people face to face but it is not absolutely necessary to be physically in the lab every day. And I have lost count of how many times I have driven 1 or 2 hours just to meet with people who I could have spoken to via teleconference/videoconference.

Being an introvert, I must admit I am not a huge fan of teleconferences and videoconferences. I need those non-verbal signals that one can only pick up from being face to face. But I must say I have started to get used to them. When you are doing 2 or 3 Zoom (or similar) meetings a day, you have no choice in the matter really.

So I think when the lockdown in NZ finishes, the new “normal” will likely not be as before. I will have a lower threshold for working from home when I don’t absolutely need to be at the workplace (also saving precious time on the commute), I will think twice about driving long distances for meetings and I will try and continue to embrace videoconferencing technologies.

And all the children will be back at school so I will get some peace!

Michael

What do other clinical microbiologists think?