The disease detectives
Date Posted: Thursday, May 03, 2007Author: Christen Pears
Chief of Pathology Dr Kered James
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Pathology is the Cinderella of the medical world. Although essential to the operation of any hospital, it is tucked away behind the scenes and is often overlooked. The Department of Pathology at King Edward VII Memorial Hospital recently put itself in the spotlight by throwing open its doors to the public as part of National Laboratory.
“It’s easy for people to forget we’re here because we’re not visible but we have a very wide-ranging impact, not just on the work of the hospital but also the physicians outside the hospital as a lot of the work we do is for outpatients,” explains Chief of Pathology Dr Kered James.
Pathology is the study and diagnosis of disease through examination of organs, tissues, cells and bodily fluids. The Department of Pathology at KEMH is the only full-service clinical and anatomic laboratory in Bermuda. Operating around the clock, it provides comprehensive services that include blood transfusion, histopathology, cytopathology, haematology, chemistry and microbiology.
Dr James says: “It’s a well-recognised fact that 70 per cent of a patient’s record comprises information from the lab and we provide an enormous amount of information to the physicians treating patients. Although we are not in the immediate frontline in terms of being there by the beds, we have enormous input into patient care. We may be in the lab but our focus is on the patient.”
The Department of Pathology plays a vital role in the timely diagnosis and treatment of illness. The results of laboratory tests often identify the presence of disease in its earliest stages, when the possibilities of a cure are greatest and when treatment is least costly. Pap smears, for example, use the latest liquid based cytology techniques to detect any abnormality. They also identify whether the patient is at high or low risk from the cervical cancer-causing HPV virus. Those in the high risk bracket will be advised to have more regular screening to ensure any problems are picked up at the earliest opportunity.
Pathology services are extensive and the workload is heavy. Haematology and transfusion, for example, average about 4,000 outpatient and 1,000 inpatient tests per month, while chemistry processes approximately 6,750 specimens each month. Approximately 127 autopsies are performed each year and the blood donor centre collects about 2,600 donations annually to support the island’s need for blood products.
There are around 40 members of staff in the department, working in a variety of roles. These include consultants, doctors, scientists and technologists, as well as nursing and clerical staff.
“It’s the technologists we want to celebrate this week. They’re skilled, scientific individuals who work hard to generate the high quality results we produce.”
As with pathology departments around the world, KEMH often finds itself understaffed but Dr James hopes Lab Week will encourage more young people to consider pathology as a profession. A number of school groups from across Bermuda visited the department during the event.
“We’re always really keen on bringing youngsters into the department to expose them to the some of the exciting careers that are open to those who are interested in science. I hope they got a sense of how exciting our jobs can be.
“It’s not CSI but we are detectives. One of the students asked me whether my days were always the same. I said absolutely not. I can have a plan for the day but the cases that come across my desk are completely different. I never know what it’s going to be and that’s something I relish. It’s interesting and unpredictable. There’s always something new to learn and I never feel as if I’ve got stale.”
Dr James graduated from the Royal Free in London and soon decided that she wanted to specialize in pathology, anatomic pathology in particular. She worked at several hospitals in the UK before moving to the United Arab Emirates and then Bermuda.
“It’s a wonderful place to work and I have a fantastic department. One of the things you all feel is that there are always patients at the other end of it. The fact you manage to resolve a knotty problem and then tell the physician the solution is so rewarding. You know the physician can’t treat the patient without all the information given them. That makes you want to come into work every day.”
Dr James has been a pathologist for more than 20 years, during which time she has seen enormous changes due to advances in technology, particularly in the areas that lend themselves to automation such as chemistry and haematology. There has been an impact even in fields that are traditionally much more manual, such as blood transfusion and microbiology. In anatomic pathology the final diagnosis is still made by a consultant looking down a microscope but the preparation of the specimens has moved on. There is, for example, a machine that stains the samples before they’re viewed and another that puts them in coverslips.
“When I first went into pathology, it was hard to envisage how technology was going to have an impact. For all of us, information technology has made our jobs so much easier in terms of generating reports and being able to retrieve information. If someone wants to know how many carcinomas we’ve had over the last 10 years I can tell them in minutes. The benefits for the patients have been enormous, too, and at the end of the day that’s all that matters to us.”