Tag Archives: microbiology laboratory

“Perfect is the enemy of good (microbiology)”

The Art of Microbiology, ,

This quote attributed to Voltaire (“Le mieux est l’ennemi du bien”), rings true to me. I have never been a perfectionist, and the idealistic pursuit of perfectionism can hinder real-life achievement and progress. 

The quote came back into my conciousness during the early days of the COVID pandemic when I listened to a great speech by Dr Mike Ryan from the WHO when urging countries to act quickly in the face of the rapidly developing COVID situation.

Of course, such a concept can also apply to the microbiology laboratory.. Here are a few examples:

Protracted work-up of samples: When a sample arrives into the microbiology laboratory, the clock is ticking. In relentless pursuit of isolating that fastidious bacterium, time passes by and before you know it a week has passed… The clinical usefulness of a microbiological result is inversely proportional to the time spent to produce it. In the hospital setting, the average length of stay is 3-4 days… Excessive time spent on certain samples is not only a waste of resources, it also generally does nothing for the patient. Get a result out, even if it is not the perfect one that you are striving for.

Excessive work-up of samples: The classic example of this is identifying every bacterial isolate in a mixture of enteric flora. For the most part, such an exercise is futile, even when isolated from a sterile site. Enteric flora isolated from sterile sites usually represent a source control issue, and who knows what the pathogen might be in the mixture, if any. Such practice is generally a waste of resources, and reporting individual isolates along with individual susceptibilities is time-consuming and often leads to poor antimicrobial stewardship. Working up bacteria within a mixture of enteric flora might be “technically perfect” but does little to help the patient.

Excessive testing protocols: A good example of this is stool samples arriving into the microbiology laboratory. There are many microbiological tests that one can do with a stool sample, culture, PCR for bacterial & viral pathogens, microscopy for parasites, C. difficile testing, the list goes on. However, to perform all the available tests on every stool sample in the hope of maximising the odds of isolating a pathogen would be incredibly expensive, but in most cases would do little to change patient management. Enteric testing should very much be tailored depending on what is on the microbiology request form.

I am sure there are many other examples that one could think of. Perfection in the microbiology laboratory is very much a pipe dream, and can actually be detrimental to good patient care. We cannot possibly hope to identify all potential pathogens in every sample and do it in a timeframe that is beneficial to the patient. We need to move past our fear of missing something…

When developing testing methodologies or reviewing individual patient samples, we should always be asking ourselves “By doing what we are doing, are we providing overall value to the patient?” 

Michael

 

 

“Going on leave…or not?”

Confessions of a Microbiologist, ,

When an “Out of office autoreply” is received into your inbox, it is increasingly common to get something like this…

“Please note I am on annual leave for the next two weeks. I will only be checking my emails intermittently.”

Hmmm….

There are two reasons why this “halfway house” is a bad idea, regardless of your responsibilities or seniority. Firstly, by checking your emails at all, you are not getting away from work completely. By checking your emails, you will never get work out of your mind, the things in the laboratory which were stressing you will still be stressing you, defeating the purpose of leave in the first place. Time is a great healer…

And secondly, by checking emails whilst on leave, you are giving the perception of distrust for those colleagues who are covering for you. Leave them to it. They are more than capable.

There is not much that cannot wait in the microbiology laboratory. And anything that cannot wait, should never be sent by email.

With smartphones, the temptation to keep in touch with work whilst on leave is almost overwhelming. Don’t do it! Switch the notifications off. Even better disconnect the email app from the server. Remove yourself from temptation, you will still have a job to go back to when you return, and people won’t think any less of you because you have been totally incommunicado during your holidays. In fact they may well have a grudging respect….

Enjoy your holidays, spend quality time with your family, and forget all about work for a while. You will likely come back rejuvenated, and ready to provide value to your microbiology laboratory.

Trust me, the sky will not fall because you are not there.

So the next time you are on leave, put something like the following on your out of office autoreply.

“I am on leave until date X. Person Y is covering for me. If necessary I will get back to you on my return.”

Take leave like you mean it!

Michael

p.s. Worried about that mountain of emails that awaits you on your return? Don’t be. Give yourself 1 hour exactly to clear the bulk of your inbox. Be brutal, ruthless and without remorse. Many of the email topics will have been sorted, or forgotten about. You will soon work out which emails are actually important, which in reality is about 1%!

“The Ageing Microbiologist”

Confessions of a Microbiologist,
“Predicted self-portrait in 2050.”

At the age of 44, I like to think I am not old. But I am not young either…

In my last year at primary school, the first school computer arrived, a “BBC Micro”, and it was trundled from classroom to classroom on a trolley.

Whilst at medical school in the early 1990s, email was very much a novelty, and we used to email jokes to each other in the university library. There was even a few people that had (very large) mobile phones.

I gave my first powerpoint presentation in the year 2000. Sadly it wasn’t the last…

Whilst training in clinical microbiology in the early 2000s, all the culture work-up was written on the back of the request form. The average turnaround time for a sample was still about 3 days. “APIs” were all the rage. MALDI-TOF for organism identifcation didn’t even exist. Molecular diagnostics was highly specialised and painstakingly slow. And if you had mentioned bacteriology automation, you would have been laughed out of the laboratory!

Change in the practice of microbiology is difficult to perceive from month to month, even year on year. But over a generation, and particularly the last one, it has changed out of all recognition.

Even though I am ageing, I still feel quite young. I try to observe younger microbiology scientists and clinical microbiologists and then think to myself. What do they know that I don’t? How can I upgrade my skills to match someone half my age!

The knowledge and skills that were essential for me 20 years ago are only partially useful to me today. I have had to “re-invent myself” and acquire lots of new skills; Real-time PCR, pivot tables, middleware, website development, just for starters. I have had to learn about new assays that didn’t even exist when I first qualified as a microbiologist… And I have also forgotten a lot of the old stuff.

That’s ok.

But age does have one big advantage.

Experience.

The ability to spot the unusual, to recognise patterns, to (sub-conciously) know when to follow up on a result and when it can be left alone. All these things are painstakingly learnt over time, and by learning from your previous mistakes and failures.

The combination of experience and re-invention can be a potent one.

It is easy for the ageing microbiologist to look back at how things used to be. But it is even more important to look forward and try to predict how things are going to be in the future.

Michael

Are you an ageing microbiologist? Feel free to share your experiences in the comments!