With a passion for all things ‘infection’, ‘virus’ and ‘antimicrobial resistance’, Chris is the only specialist in his field in the Waikato and tells us what he does day to day to serve the hospital wider community, and why he loves doing it.
How did you become interested in medicine?
It was a challenge, and an opportunity to do good and just really good fun learning it.
What inspired you to be a microbiologist?
Originally, a desire to do research, but later on it has turned out to be a good way to contribute a little and sometimes on a wider scale than just the individual patient.
My father was a laboratory man and I knew it was a good sort of work.
What does your job involve? What are some of the main functions?
In general terms:
- Specialist microbiology advice and support for clinicians
- Medical advice and support for the laboratory
- Liaison and expediting testing specific specimens
- Interpreting microbiology results and recommending which tests to do
- Optimising lab testing protocols to meet patient and clinicians’ needs
- Improving the quality and effectiveness of microbiology lab services
Day-to-day work is 50 per cent answering clinicians’ queries by phone and lab staff queries in person. These overlap quite a bit, as patients with difficult problems also often have difficult organisms and vice versa.
Calls come from many different specialties every week: from all branches of surgery, paediatrics, acute medicine, rehabilitation, general practice, public health and management.
I do quite a bit of planning and systems work (committees and meetings but also liaising and negotiating among people all over the hospital).
Checking and advising on technical quality and medical usefulness of testing is a major function. I do a lot of talks to lab staff and clinicians and I spend a lot of time learning, maintaining and building up technical understanding by reading, at conferences, and in discussions with microbiologists in other centres.
I collate and write a few reports like the weekly respiratory virus report in winter and antimicrobial susceptibility data.
What do you love most about your job?
The sort of work mostly suits my temperament well. It has a good technical, scientific and mathematical aspect to it and is applied every day to benefit particular patients.
The detective work and problem solving for each patient consult is great fun and larger scale projects like method development and quality improvement are also worthwhile.
It is flattering to be the only specialist in my field in the Waikato (it’s just as well I don’t mind working alone.) But also working together with others with complementary expertise, the lab scientists, the nurses, infection prevention and control people, doctors and managers, public health, computer experts, is also very good.
Interrupted tasks are virtually the only unsatisfying aspect of the job.
What are some of the challenges you face?
Optimising patient benefits with finite resources, finding and advocating wisdom in patient management, and negotiating people and organisations effectively.
How has your industry changed since you started, especially with the increase in technology?
The most important things have stayed pretty much the same: the skill and judgement of our lab scientists and clinicians. These are just as crucial as ever and technological advance just slightly broadens their capability to help patients.
The introduction of PCR (polymerase chain reaction), better understanding of antimicrobial resistance, improved quality management systems and improved computer support are the four developments which have most enhanced patient care in microbiology.
The paradigm of ‘newly aquired organism = new treatable disease’ has also become the simple exception among complex cases, where opportunistic infection by resident flora, chronic infection and enigmatic conditions of perturbed host response seem to be a larger part of our work.
What are some of the interesting things you have come across over the years as a microbiologist?
The strangest case would be the chicken shed worker who suffered from small mites living in his ears. We couldn’t definitively identify the species but presumed they came from the grain in the chicken feed which he was showered in daily.
I’ve never heard of it before or since and I suspect that a large number of infections are one-offs unique to each patient and difficult to diagnose or classify.
On a global scale, SARS was an enigmatic condition, with initially explosive spread and fearsome case fatality rate, but then apparently died out under the pressure of standard infection control measures. It was such a threat but now seems to have become extinct in humans.
Just why did this happen and how can we manoeuver other troublesome outbreaks into the same place?
Every case is interesting; even those which come right with little fuss and achieve a complete cure.
Among cases which created a bit more fuss, several patients with actinomyces infection in the Waikato do stay in my mind. Microbiologically, it is so simple to treat: six months of IV amoxicillin and sometimes surgery.
The organism is a normal inhabitant of the mouth and bowel and only rarely invades to cause its characteristic abscesses, hard infected masses of tissue and draining sores after tooth infections or appendicitis. It is so easy to suppress with antibiotics, yet difficult to eradicate completely.
The organism is almost impossible to capture in the microbiology lab and often only diagnosed by histopathology or recognising the classical clinical picture.
None of these cases would have progressed so far if they had more access to healthcare and all eventually responded to long courses of antibiotics.