Tag Archives: clinical microbiologist

“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?

“When the patient and the microbiology lab don’t agree”

Confessions of a Microbiologist,

I am signing out blood culture results. A patient has an E. coli resistant to amoxycillin clavulanate (augmentin) in both their blood culture and urine specimen. I ring up the patient’s doctor to see how the patient is doing. The patient is currently on augmentin but is nevertheless feeling much better, has been switched to oral augmentin and is ready to be discharged home. Hmm… What should I do? Should I change the antibiotic or am I just treating myself rather than the patient…?

Or the patient who develops a post-operative wound infection and they get treated empirically with flucloxacillin, to which they “respond” well, becoming afebrile and the wound discharge dries up. A swab of the wound then grows an MRSA. Should they complete their course of flucloxacillin or should they switch to an antibiotic to which the MRSA is susceptible to?

The joys of being a clinical microbiologist!

These scenarios have a few possible explanations:

  • Some patients will get better from infections, even bacteraemias and septicaemias, whatever you have used to treat them. Not all patients who contracted infections in the pre-antibiotic era succumbed to them.
  • Just because an antibiotic has tested resistant in the lab does not mean there will be no clinical response. Lots of other factors come into play here, e.g. dosage and pharmacokinetics, penetration into site of infection, host immunity, etc.
  • The isolated pathogen is not actually the cause of infection.

Clinical microbiologists are often left in a difficult situation here. Do they listen to the laboratory telling them that the isolate is resistant to an antibiotic, or do they listen to the clinician telling them that the patient is better. And what happens if they listen to the clinician and then the patient takes a turn for the worse…

It is almost a no-win situation. Is it any wonder that older, more experienced clinical microbiologists like myself end up becoming slightly insane!

These scenarios, or something similar happens to me every few weeks. It is not often discussed how to approach this situation, and it is probably glossed over somewhat in clinical microbiologist training. I was certainly never trained how to deal with it. In fact it could even be regarded as something of a taboo subject…

I think the answer lies in a case by case approach, taking into account the type of infection, the pathogenicity of the organism, the degree of resistance to the antibiotic, the reserves of the patient and how unwell they were on presentation, and a multitude of other factors that cannot possibly be learned from a textbook.

There is a lot of science in microbiology, but sometimes experience, intuition and common sense count even more than knowledge. Antimicrobial susceptibility results are important, but they are not the whole story by any stretch of the imagination.

Michael

Apologies for the paucity of posts recently, a combination of busyness and laziness!

 

“The Charlatan Microbiologist”

Confessions of a Microbiologist,

I still get a little nervous every time my work phone rings…

Will it be a question that I am unable to answer? (I get a few of these)

Will it be a complaint about a result or some aspect of laboratory policy. (I get quite a few of these as well..)

Or will it just be a standard “bread and butter” clinical enquiry where the answer is engrained in my cerebellum?

Fear of the unknown…

I am not very good at remembering the 3rd line treatment for recalcitrant giardiasis.

I am not very good at thinking on my feet, especially in a stressful situation.

and I am not very good at documenting all the clinical advice I give out.

Sometimes I feel like a bit of a fraud…

But then I remember the things I am good at.

I am good at building relationships with clinicians and gaining their trust.

I am good at turning the conversation from “result interpretation” into “patient interpretation”

I am good at diffusing complaints with a healthy dose of empathy and a bit of Irish charm.

I am good at knowing when and who to ask if I have a difficult microbiological problem.

On reflection, I am not completely useless.

Maybe we are all charlatans in some respect. We all have limits to our microbiological knowledge, our patience, our energy reserves.

And it is good to remind ourselves that it is often the non-microbiological aspects of our job that are the most important…

Michael