Laboratory 10/19/15 8:30-11:00

Today I had the opportunity to shadow Dr. Mike Astion, the Laboratory Medical Director.
Ill just cut to the chase: I now know that I never want to work in the lab and I never want to be a
medical director. I will say that it was really cool getting to see behind the scenes of what goes
on in the hospital. My exposure to the lab has been dropping off a sample, catching a glimpse of
the benches and the machines, but nothing beyond that. I didnt really realize how vital the
laboratory is to the functioning of the entire hospital. Every test, every blood sample, culture, and
what not goes to the lab. I learned that that means things can get pretty hectic, especially for labs
coming from the ED that need to be taken care of stat, and the 200+ patients in house who are
constantly being monitored.
Dr. Astion showed us a lot of stuff and really fast too, so I cant be blamed for not
remembering everything. He took us to each of the different sections of the lab, each specializing
in a different field: microbiology, histology, cancer/genetics analysis, etc. The lab was full of
refrigerators holding blood (the ones with platelets are the ones that shake back and forth), there
were shelves upon shelves of plated specimens, there were PCR machines and mass
spectroscopy machinesit was cool getting to see all the things that wed read about in O-chem
and Bio class being used in the real world.
But the thing is, its not my world. My world is in a room, with a patient, seeing how I
can help them directly. In Laboratory, there is virtually zero patient contact. The extent of it was
when Dr. Astion had to clear up a case in which a patients test had not been received by the
physician (failure to retrieve is what its called when this happens), which was a major issue
because the test had been positive for a certain disease. This is apparently one of the three big
ways that physicians gets sued for malpractice (the other two being an incorrect interpretation of
a test and administering the incorrect test). So Dr. Astion had to review the chart and
acknowledge that there was a diagnostic delay for the patient, which would result in the patient
not being charged for the care they received. But that was it. Dr. Astions involvement with the
patient was purely administrative, as is the rest of his job. As he told me rather candidly, his job
is all management. He said that hes not medical director because hes the best doctor, those are
the pathologists making diagnoses and analyzing the samples. Hes medical director because he
wants to work crazy hours doing this administrative side of things, and hes a people person so
he can get along with all the people in the laboratory he has to manage. So admin is definitely
not for me, because although I can get along with people, I just wouldnt feel like I was a doctor
if I wasnt seeing patients.
Having not shadowed any pathologists, I cant say this with absolute certainty, but Im
99.99% sure that thats the case (it was cool when I walked into the lab seeing a team of
pathologists all looking into microscopes which were hooked up to a single slide so that they
could all see the same thing at the same time and discuss what they were seeing). The science of
medicine is certainly interesting, but thats not the sole reason that I want to be in medicine, and I
feel like the laboratory is for those souls who are just in love with science.
Its funny, but when we walked in, another physician who we hung out with, Dr.
Chandler, asked us if we were business students. I was a little taken aback by this question at
first, because it seemed pretty dumb if we were shadowing a doctor that we would be business
students. But thats really what being medical director is. Its business management. A lot of the
things that Dr. Astion showed us was how to run a business efficiently. He showed us the proper
way to keep things stocked so that nothing was wasted and nothing was over ordered. The lab
actually runs on the Toyota system that Ive read about. As for Dr. Astion, he described his job as

a three-fold task: Strategizing, Breakthrough, and Daily Operations. He showed us a lot of Daily
Operations (meeting with section heads, seeing how they managed the benches within each
section, getting everyone on the same page for things). Strategizing is kind of implementing a
direction for the laboratory. It involves a lot of researching and being aware of whats going on in
the country, in terms of how to improve the lab and what directions to take and projects to
pursue. Breakthrough is making that Strategizing happen.
So I guess what Ill say is that my impression of what I saw was more important than
what I saw. And my impression is that while I appreciate everything the laboratory does, its
definitely not my thing. The patients are who I identify with, those are the people that I want to
be working with. To me, thats what being a doctor is all about, and I would never feel
accomplished if I worked in the lab.