The Pathology Report

10 Questions for Dr.  Jacob Pendergrast

What is your position?

Transfusion medicine specialist

What do you do here?

Along with Dr. Cserti-Gazdewich, I serve as associate medical director of UHN’s Blood Transfusion Service.  I also provide Medical Directorship of the Blood Transfusion Services of several community hospitals within Ontario who have contracts with UHN’s Laboratory Medicine Program.  Finally, I have a cross appointment in the Department of Medicine where I attend in the Red Blood Cell Disorders program at  TGH and provide coverage to the hematology consult service within UHN and Mount Sinai Hospital

Why did you get into lab medicine?

When I decided to go into medicine, I was motivated by the idea of all patients having access to the same, high quality health care regardless of the particular circumstances of where they lived or even who their doctor happened to be. When I decided to pursue subspecialty training in clinical hematology, after completing my internal medicine residency, it was with the plan that I would follow that with further training in transfusion medicine, an area I thought this principle would be especially relevant.

How did you get started at UHN?

I’m from Toronto and, although my undergraduate studies were in Montreal and Halifax, my post-graduate medical training was here and seemed like a natural progression

How long have you worked here?

My residency training in Toronto started in 1999 and I took a staff position at UHN in 2006.

What is the favorite part of your job?

The incredible variety of experience!  The blood transfusion service reaches into areas of clinical practice that I might otherwise have little exposure to. There is also a wonderful amount of “cross-talk” between the blood bank and other laboratories, particularly the coagulation, HLA and microbiology labs.

What is the most challenging part of your job?

Having patience.  There are always so many people affected by even the smallest of changes, and there are definitely days when I wonder if I can sit through one more meeting or conference call!

What value would you say you add to patient care?

I think I bring an unwillingness to accept mediocre patient care. I’m sure many people agree that there are so many things we do here that are maybe good enough to avoid major catastrophes, but which we aren’t actually very happy about.  These things, even the little ones, tend to itch at me.

The overall mission of LMP is to advance lab medicine in its three functional pillars: research, education and clinical service. How would you say you support this mission?

I probably spend at least a third of my time teaching or preparing the remainder of my time is mostly clinical service.  I am at a stage in my career where I want to start carving out more time for research activities. Toronto has the capacity to become the country’s pre-eminent research centre in transfusion medicine.

In LMP, we often talk about serving as “global leaders” – what do you do to serve as a “global leader”?

Patients have benefited from the highly sub-specialized expertise that has emerged within the modern medical system, but the flip side of this is that there is always a risk of our becoming completely pre-occupied with what is going on within our own little silos. Those times I have felt like I was leading, it was when I convinced people to venture outside of their “safe zones” and start collaborating with people on the other side of the fence.

 

10 Questions for Sarah James

What is your position?

Senior Pathologists’ Assistant

What do you do here?

We do all the gross description, sampling and photos of clinical and surgical specimens and autopsy. We also prepare, orient and fix specimens, take samples for research banking and teach.  As the senior I also do scheduling, liaise with pathologists, and administrative work.

Why did you get into Lab medicine?

As an immigrant from England I had the wrong high school credits to get into pre-med and my school encouraged me to take engineering. I was thinking about medicine as I wanted to design artificial limbs. Engineering wasn’t for me and when I needed to pay my bills I chose lab medicine as it was the fastest route to get me into a job related to medicine.

How did you get started at UHN?

When my friend and mentor told me she was vacating her position at UHN I weighed the pros and cons of staying at or leaving my then current job. Meeting with staff at UHN made me realize what opportunity there was here and how I could excel.

How long have you worked here?

This will be my 5th year.

What is your favorite part of the job?

I love teaching residents and new PAs how to gross specimens from tiny to really complex. Watching people’s confidence grow as they learn what they are doing and why is not equaled by anything else.

What is the most challenging part of your job?

Finding the balance between getting the work done and going beyond the standard of care. Sometimes it is hard not to gross the specimen down to the tiniest little vessel because it is just so fascinating. Anatomy does that to you!

What value would you say you add to patient care?

PAs allow a pathologist to diagnose disease. In cases where there is already a diagnosis, the pathologist is able to provide the rest of the medical team with information to help best manage that patient’s care.

How would you say you support the LMP mission to advance lab medicine in its three foundational pillars: research, education and clinical service?

With research, we bank samples for current or future research studies. I also spend lots of time with grossing education. Last year I worked with U of T to have the PAs present grossing techniques at summer lectures for residents coming into pathology. A colleague and I developed two online courses at the Michener institute and I am the Chair of the Conference Committee for the PA Section of the CAP-ACP. When it comes to clinical service I attend educational sessions, talk to pathologists and read papers about what is current, new and upcoming.

In LMP, we often talk about serving as “global leaders” – what do you do to serve as a global leader?

I support the PAs at our partner sites helping them with grossing questions, dragon issues and keeping them updated with new protocols. I’ll even jump on a plane to help out! Nationally, I work CAP-ACP with grand parenting criteria, continuing education requirements and certification for the PAs across Canada. I have also recently assisted the province of Alberta with setting up their provincial voice recognition program by sharing my “Dragon” experiences.

 

If you needed care from a hospital, you would want to know that you were getting the best possible care available. And you would take comfort in knowing that everyone is working to make you better, everyone including the doctors, nurses, phlebotomists, and lab technologists -  all doing their best to get you the information needed to manage your health.

 

In addition to the fact that our work is always of high quality, it is also highly reliable. We need to deliver the same “gold standard” of care to every patient, the same way that they would want that care delivered to themselves.

We think this gold standard is what makes our fellow clinicians and health care providers rely so strongly on our lab.  We don’t just do the minimum, because that’s not what our patients deserve. We hold our heads up high as leaders in laboratory medicine around the world because of this promise and how it defines who we are.

When we talk strategy, we use terms like “early adopter”, “adding value” and “enhancing diagnostics”. These strategic concepts are how we position ourselves to get the tools we need to deliver gold-standard care. The healthcare industry is always changing – that’s why we need to be comfortable changing too. We make the technological changes when there are new pieces of equipment or new tests to deliver better care.

We are also changing how we invest in areas like molecular diagnostics, point-of-care and biobanking. These are areas of growth within the lab that are changing the future of laboratory medicine today and we need to be a centre of excellence in these areas.

We are also changing how we work with other healthcare institutions across the province and abroad. When we work with the hospitals in the Northeast Cluster in and around Timmins, with the Sault Area Hospital, Lakeridge Health and many others, we are always looking at how to improve the services that the laboratory provides so that every patient is always receiving the same gold standard of care. It is about equitable access to expertise in laboratory medicine – regardless where you get your care.

Every day, our common goal should be to deliver nothing but the best.  Our reputation depends on it; more importantly so do our patients. We owe it to them to deliver the gold every time.

Our colleagues at Sunnybrook Health Sciences Centre have posted a great video of a patient and his journey after a propane explosion in December 2006.

Ralph Walker was brought to Sunnybrook’s Ross Tilley Burn Centre, the only burn centre in Ontario with a donor skin bank, where the first of many surgeries took place. He says he is only alive today thanks to the multiple skin grafts from donors that allowed his body the time it needed to heal.

The Blood and Tissue Bank at Sunnybrook is part of their Division of Laboratory Medicine, which is a major partner with the Laboratory Medicine Program here at UHN. It’s valuable to see and learn about the great work that our partner sites are doing for patient care.

Take a look!

10 Questions for Dr. Rita Selby

 

What is your position?

I am the Medical Director of the Coagulation Laboratory, both here at UHN and at Sunnybrook, dividing my time each week between the two hospitals. I am a clinical hematologist by training specializing in disorders of thrombosis and hemostasis and also have a small inpatient and outpatient practice in this area.

What do you do here?

UHN has a large, academic, regional coagulation laboratory that provides services and medical directorship to many areas of Ontario. We do the specialized coagulation testing – Factor assays and Von Willebrand screening, testing for congenital and acquired thrombophilias, HIT testing and other routine and esoteric coagulation assays – for Lifelabs and several large regional hospitals. We also provide medical directorship and technical assistance in coagulation to our partner hospitals in Northern Ontario. I oversee this operation and provide interpretive reporting for all abnormal coagulation test results for all of UHN and its partners.

Why did you get into lab medicine?

 While some in lab medicine are passionate about engaging in new discoveries, I am passionate about trying to implement what we already know works well. Running two regional coagulation laboratories that through their partnerships service such a large swath of Ontario provides me many opportunities for working towards standardization of laboratory practices, implementing best practices and guidelines that improve coagulation quality and defining sensible future priorities for our area.

How did you get started at UHN?

 I was recruited to UHN as the Medical Director of the coagulation laboratory by Dr. Marciano Reis and Dr. Sylvia Asa in 2008. Their goal was to build inter-hospital collaboration in coagulation in Toronto (similar to what has been done in Transfusion Medicine). I have been the Medical Director of the Sunnybrook regional coagulation laboratory since 2001.

How long have you worked here?

Although I have been on faculty at UHN since September of 2008, I feel like I have “worked” at UHN for most of my professional life. I was an internal medicine and hematology resident at UHN from 1993 to1998 and so UHN already felt like home to me when I returned as staff.

What is the favorite part of your job?

Seeing and reporting interesting cases, discussing coagulation quandaries with my medical and technical colleagues, being a resource to colleagues across Ontario on thrombosis and hemostasis disorders and anticoagulant drugs – these are the favourite parts of my job.

What is the most challenging part of your job?

 The most challenging part of my job is the lack of senior technical expertise in coagulation across the country and the inappropriate utilization of specialized coagulation testing.

What value would you say you add to patient care?

I try to do my best everyday to ensure best practices and quality in my labs.

The overall mission of LMP is to advance lab medicine in its three functional pillars: research, education and clinical service. How would you say you support this mission?

I am currently the co-principal investigator on a multi-centre, cross-Canada study looking at the resource utilization associated with warfarin therapy in patients with atrial fibrillation and have previously been principal investigator or site investigator on several clinical trials in thrombosis. I have also supervised several lab-based trainee projects. Our coagulation laboratory has been a training site for 6 to 8 hematology and hematopathology residents each year since 2009. Our 4 week rotation is part of the core curriculum for these trainees and the only coagulation lab training they get during their residency. The UHN coagulation laboratory through its several partnerships with Lifelabs and many hospitals has an integral clinical service role.

In LMP, we often talk about serving as “global leaders” – what do you do to serve as a “global leader”?

I am a member of the QMP-LS Hematology committee that oversees external proficiency testing and develops guidelines for the province of Ontario’s hematology labs. I am also serving on a CLSI committee (with international representation) that is developing guidelines for lupus anticoagulant testing. In 2010 I was asked to chair a Meet-the-Expert session on “The laboratory and venous thromboembolism” at the American Society of Hematology annual meeting. I am an expert advisor to OLIS (E-Health) on coagulation test nomenclature. I, along with several colleagues, have received a grant from the Ontario Regional Blood Coordinating Network (ORBCON) to develop a basic Coagulation handbook for health professionals in Ontario which we hope will in some part help address the knowledge gap.

 

10 Questions for Kwabena Boateng

 

 

What is your position?

Medical Laboratory Technologist (MLT)

What do you do here?

I am part of the front line staff in Hematology that deals with Complete Blood Counts (CBC), Morphology, Coagulation test, Manual Testing (including Spinal Fluids, ascetic fluids, synovial fluids, Malaria Parasite Identification etc….)

Why did you get into lab medicine?

Laboratory medicine currently ranks as the third largest sector in the Healthcare in Canada even though we remain anonymous. Presently, there is no career rewarding than this as the passion for science has always being in my DNA. My journey begun around 1994 when I was delayed coming to Canada due certain laboratory results that needed to be confirmed. That incident caught my attention and my passion for Laboratory work has not waned since.

How did you get started at UHN?

This is personal story I am hoping to publish one day. The journey was a long process but thanks to Marni Lollo and Fatima Cardoso, our lab manager and supervisor for hematology, for bringing me on-board. The good news is, I have managed to bring two impactful people currently helping advance Laboratory Medicine Program’s vision.

How long have you worked here?

About three years.

What is the favorite part of your job?

There are many elements associated with this field ranging from quality assurance programs, troubleshooting instruments, teaching students/new employees, conducting mini-projects etc. The above mentioned add to the excitement this job brings. It is always a delight to see some of the students we groomed don the LMP uniform and become flag bearers for our mission/vision.

What is the most challenging part of your job?

Laboratory work share certain roots with management. You never know what you might walk into when you come to work or open your first email. You can start your day with STAT Malaria test with a strict one hour turn-around time (TAT). Operating at the Lean SIX SIGMA level always adds value to customer satisfaction, but delivering the highest quality lab result is always key.

What value would you say you add to patient care?

Statistics clearly shows that up-to 85% of patient Diagnosis solely depends on Laboratory work. Nevertheless, being the third largest profession in healthcare in Canada implies that our contribution to patient care is crucial. Princess Margaret ranks among the top 5 Cancer Hospitals in the world. Being able to deliver highest quality laboratory results to meet patient needs is something I take pride in.

How would you say you support the LMP mission to advance lab medicine in its three foundational pillars: research, education and clinical service?

To meet these challenges, LMP is building a strong foundation in research methodologies, clinical practice and continuing education. I believe we are on the right track.

In LMP, we often talk about serving as “global leaders” – what do you do to serve as a “global leader”?

I am currently working on a project that will help advance Laboratory Medicine in places like Africa (Ghana). The foundation is in place and hoping to get support from LMP leadership when it fully launches. We are currently affiliated with KORLE-BU Teaching Hospital in Ghana (the biggest teaching Hospital in Ghana) and few small Clinics in Ashanti Region (Ghana). The project is still in its infancy, but one of my philosophies has always being: “Every Big Dream Starts with a Small Vision; Every small Vision Starts with a Big Dream.” There is no better place to find that Vision and Big dream than in the Laboratory Medicine Program at UHN.

When we describe our laboratory, we often use the phrase “biggest diagnostic lab in Canada.” But, how many of us know what that really means? We also say how across our entire laboratory partnerships, that there are over 500 staff and more than 70 medical scientific staff working together within LMP. But, we appreciate how when you only see the people on your floor, or at your bench, then those numbers may lose a bit of meaning.

Our size, scope and complexity can be difficult to grasp sometimes; one of those “can’t see the forest for the trees” situations that can happen in a large organization. Yes, you may work in histology or your work space is based out of a specific site, but we are all part of LMP and every one of us adds tremendous value to the patients inside the walls of our hospital, and the patients of our partner sites.

We are very large in size when it comes to our partnerships and our reach. We provide a Medical Directorship to 16 other hospital laboratories in Ontario and we provide laboratory medicine services to over 150 hospitals across Canada. Plus, we’re involved in the Kuwait project at KCCC. This means we extend beyond our walls and reaches innumerable patients and clinicians who can access high quality laboratory expertise that guides their care.

This scope also provides us with an opportunity for innovation and collaboration in providing and adopting new technology and science from around the world. Telepathology, Molecular Diagnostics and Biobanking are just three examples of where we are investing our time and resources because we know this is where laboratory medicine is heading today and tomorrow. We need to be leading, not following.

Our close, working relationship with other clinical programs makes us stronger and better. POCT is a great example that excels in this area as they work closely with all our clinical partners. The reintroduction of biochemistry at the Princess Margaret is another, as our team worked alongside the clinics to work out all the details. Also, because our pathology department is subspecialized based on site group – neuro, kidney, head and neck, etc – we can provide a level of detailed, comprehensive reports that allow clinicians a level of in-depth synoptic reporting unseen in other health centres.

Every day, everyone in LMP plays an important role in the delivery of complex, high quality patient care to our patients. Whether you work in the Core Lab, Blood Transfusion, HLA or any other of the hardworking areas of LMP, it should be a comfort to know that you are a key part of delivering world class care to our patients.

The rain was pouring down and the puddles were deep enough to soak your ankle, but the Lab Lifesavers team was ready, confident and looking forward to the challenge. Joining almost 4,700 other participants, the Lab Lifesavers were taking part in the 10th annual Weekend to End Women’s Cancer in support of the Campbell Family Institute and the Princess Margaret Hospital

 

The team was dripping wet from the rain on Saturday morning, but spirits were high as they left the starting line at the Prince’s Gates at the Canadian National Exhibition and began their 60 km trek from the lake and made their way up to Downsview Park, and then back again on the Sunday. The Lab Lifesavers team consisted of Dr. Sylvia Asa, Yvonne Bedford, Brad Davis and Michele Henry from administration, Marjan Rouzbahman from Pathology, Sally Balmer and Stephen FitzGibbon from Blood Transfusion, Dianne Chadwick from BioBank, Shawn Brennan from Cytogenetics and Nayana Sondi from LIS – together the Lab Lifesavers raised $32,620 in the fight against women’s cancers, coming in at #43 of 612 corporate teams.

 

According to the team, Day One was the toughest due to the heavy downpour of rain. They were all decked out in rain ponchos, but their shoes were quickly soaked due to some ankle deep water that had flooded near the Lakeshore.

 

While the majority of participants walked the first 32 km on Day One, Yvonne broke from the pack and ran the entire thing on the first day – all 32 km – and made it up to Downsview Park before some of the organizers.

 

The walk also took the team right past our “home” by heading up University Ave and past Toronto General Hospital and the Princess Margaret. Dianne Chadwick explains that “our spirits remained high, particularly when we saw familiar faces including Drs. Tak Mak and Chris Paige who were cheering us on in front of PMH.”

 

Dianne adds that “one of the most inspiring moments was seeing Kitty, a 99 year old walker all in pink, wearing a sign that read ‘I’m 99 and feeling fine!’ We were thinking ‘I’m feeling 99 and not so fine,’ but if she could do it, so could we.”

 

This was the first year that the labs participated as a team, but for the past ten years, the Weekend walk has raised over $120 million for the Princess Margaret. These donations have gone to good use as there have been groundbreaking strides in the fight against women’s cancers and thousands of lives have been saved over the years.

Stephen FitzGibbon says this was the first time he participated in the Weekend to End Women’s Cancer’s event. Stephen was “impressed by the enthusiasm and determination that all of the walkers exhibited throughout the weekend. I saw walkers suffering from blisters, pulled muscles, etc. who bravely carried on to the finish line each day. Despite the poor weather and the aches and pains, the walker’s spirits remained high.”

 

For Stephen, the event was very personal as he “walked in support of my wife Loraine. Three years ago she was diagnosed with breast cancer. She underwent two surgeries, surgical complications requiring extensive wound care, followed by almost a year of chemotherapy. Throughout it all she remained upbeat, never complaining about the pain or nausea that she suffered from. I hope that next year we can organize an even larger team to participate in this event.” 

 

According to Sally Balmer, her reason for walking was also personal, “I walked for Mary Guiniaoan.  Mary worked in blood bank up until she died in April 2011 and her courage throughout her illness with cancer was amazing and it inspired me to join the walk. I thought of her many times during the walk when I needed courage to go on and her memory got me to the finish line.”

 

Brad Davis pointed out that “the walk provided just another example of why lab people are #1… I think a lot of us signed up (or allowed ourselves to be drafted), not knowing how we would complete the walks – but knew it was something that had to be done. It is very much like the challenges our staff face every day…we just figure it out!!”

 

He added that he “enjoyed the opportunity to have long chats along the away about everything – and seeing others walking, even patients in treatment, along with a 99 year old lady walking – it was just purely inspirational!”

According to Michele Henry, “I’ve volunteered at the event before, but it was a whole different experience doing it as a walker. I participated because the Lab Lifesavers was a great team event, but I mostly walked in honour of my mom who was treated at PMH for gynae cancer. If she could have radiation every day for months, I could walk 60K for a great cause.

 

She added that “hearing the stories of fellow walker and the support from the community was overwhelming, families outside with all their children in pink offering food water and coffee with Baileys was truly inspiring.  Whether we ran or limped across the finish line it was a great accomplishment for all.”

 

Shawn Brennan explained how “it was a fun walk in spite of the rain with no bumps or blisters – hurray!”

 

On Day Two, the weather was much better for the walkers as the sun was out and the temperature was comfortably cool. The trail went through Humber Park and Bloor West village and along the boardwalk on the lake. When the team reached the 60 km mark at the CNE, supporters were lined up on both sides cheering everyone on. 

 

It “made us feel like Olympians!” said Dianne.

 

The Lab Lifesavers team was led by Dr. Sylvia Asa, Medical Director for the Laboratory Medicine Program and she is incredibly proud of the team, the funds the team raised for the Princess Margaret, and seeing how many people came together to support the fight against cancer.

 

“Walking with our team was very inspiring – and seeing all the other teams and groups from other organizations and businesses really made us feel like we were part of a big movement, making a difference in the fight against cancer,” said Dr. Asa.

 

“It was great to do this as a team, to talk with one another and really get to know each other. We were also encouraged by the route volunteers, some of which dressed their bikes – or themselves – in glaring pink bras filled with balloons to have a little fun along the way,” she added. “We were also pleased to see Toronto unite for this great cause as a community; seeing the families with snack stations and water, walking past little kids on their lawn handing us treats. It made us feel like we were all in this fight together.” 

 

Dr. Asa says that, “next year our Lab Lifesavers team will be bigger, our team will raise even more money and we will make an even bigger impact in our fight to conquer cancer in our lifetime.”

Recently, Dr. Sylvia Asa, Medical Director, LMP, gave a talk about the impact of pathology and personalized medicine.

The talk was part of The Princess Margaret “Believe It” billion dollar challenge, a 5-year initiative to secure $1 Billion to revolutionize cancer care by creating a new gold standard.

Personalized Cancer Medicine and Pathology.

In her presentation, Dr. Asa outlines the traditional role of pathology and how our medical team attempts to say what is wrong with the patient (the diagnosis), how is this disease likely to behave (the prognosis) and how should we treat it and what is it most likely to respond to (prediction).

When pathologists talk about personalized medicine, we are talking about what is your diagnosis, prognosis and how are you best able to be treated in order to have the best outcome.

But with the new research, increased amounts of information available on each patient from genetic information – what will pathologists do with it? And how will it affect the diagnosis, prognosis and outcome?

Take a look – -