lessons learned from micro

My first three months of residency were spent in the microbiology department. Aside from learning a whole lot (though, of course, never enough) about various organisms, diseases, and lab tests, I walked away having picked up a few other helpful tips -- ones I think would be important to all physicians, not just pathologists.

So, here are my "lessons learned" from microbiology:

Some labs take a while
As a medical student, I remember checking culture reports every day, wondering why it was taking so long for information to come back. Now I know. Aside from a Gram stain, which is relatively quick and easy but doesn't tell you a whole lot, these tests take a while to get done right. The blood samples have to incubate for a day or two. If positive, then the Gram stain is performed and a culture plate is prepared. That's another few days for the organism to grow right there. Then it goes through the machine that tells us exactly what kind of organism it is and what antibiotics it's susceptible to. Some of the specimens -- fungal and AFB specimens -- have to sit for weeks and weeks before a lack of growth can comfortably be called negative. It stinks that this all takes so long, but that's the name of the game. The lab is not slacking.

The techs know their stuff
I learned some things out of books or lectures, but most of the microbiology knowledge I gained came from the techs I watched at work. They aren't doctors, but neither was I a few months ago. They're well-trained and definitely know what they're talking about within their field. I've heard them converse with doctors and get treated like idiots, which just isn't fair. They keep things working smoothly 99% of the time, and that 1% of the time that something goes wrong, it's a genuine issue that usually is not their fault.

There are way too many microorganisms out there
Seriously. I had enough trouble keeping track of all the ones I learned in my second year of medical school. Turns out that was just scratching the surface. There are all sorts of "obscure" bacteria and parasites I've never even heard of. We had tutorial CDs that presented information on all of them. After about the 20th somewhat similar organism, your eyes start to glaze over. The microbiology fellow on the rotation with us definitely knew his stuff, but I can see why a fellowship (or even a PhD) in microbiology is essential to understanding everything that comes through the door.

A doctor runs the lab
This is possibly a "duh" statement, but I never really thought about it. At the head of the lab are MDs and PhDs making sure everything runs smoothly. You really need a medically trained person in there who can grasp the issues fully and appropriately. And this brings me to my last point ...

Lots of crazy little issues pop up
When not working with the techs and learning the basics of micro, I spent 1/3 of my time checking out interesting cases and the other 2/3 listening to troubleshooting. The micro directors have to swoop in whenever a test is acting funny, a specimen is mishandled, an outbreak appears to arise, and etc. The lab can run on autopilot for a little while, but something always comes up that pulls things off course. One skill a CP pathologist absolutely has to possess is office management.

I have a ton of ideas for posts about surg path. Hopefully I will have time to write them in November, when I'm on autopsy.