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Interviewer: Do you love science and medicine but you don't necessarily want to become a doctor or a nurse? Well, maybe a degree as a medical technologist and working in a laboratory might be for you. We'll get the inside from somebody who's chosen that as their career path next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Kristen Case is a medical technologist, also known as an MT, who specializes in parasitology and fecal testing at ARUP Laboratories which is one of the top labs in the country that specializes in identifying parasites so doctors know how to treat them. Today I want to find out more about what you do and how you got your training to do what you do. So first of all, what kind of experience do you have to have to do what you do?

Kristen: It's a specific major. It's called clinical laboratory science or medical technology. There's a program at Weber State, at BYU, and here at the University of Utah. You take specific courses about microbiology, virology, blood bank, chemistry, so it's a really fun major because you learn about all different types of things. If you like science, it's a perfect major.

Interviewer: Is this an undergraduate major?

Kristen: Yes, undergraduate major.

Interviewer: And it's called what, again?

Kristen: Medical technology.

Interviewer: Okay, medical technology.

Kristen: Or clinical laboratory science.

Interviewer: Okay, so then when you got your job at ARUP Laboratories, then that's when you started specializing in what you specialize in?

Kristen: Yes.

Interviewer: You could have done a lot of different things with this degree, so why did you choose to specialize in parasitology and fecal testing? I mean, that sounds gross to me.

Kristen: For me it's gross but it's also fascinating. It's really fun. We get to see a lot of different organisms, do a lot of different things throughout the day. I learn something new every day, and that's what's so fun about my job.

Interviewer: So help me understand how you end up with the specimens you end up with? So a doctor has a patient that comes in and the doctor is led to believe on some level there could be a parasite or what else going on. What would they do at that point?

Kristen: Usually a person will go to the doctor because they're having some type of intestinal problem. So the doctor is going to start doing a panel of testing, and testing for parasites probably is just one of those tests that they're going to order. Because we're in the United States, parasites aren't super common but it's still on the panel of tests so we get a lot of specimens in our lab. We look at them in the microscope, looking specifically for parasites. We can identify them microscopically or even using some other methodologies.

Interviewer: So usually you are looking at fecal tests? Is that what you primarily would look to find these parasites?

Kristen: Yes. The majority of our specimens are fecal specimens, but parasites are really sneaky critters and so they actually . . . we get eye specimens, pleural fluid, urine, all different types, skin scrapings, all different types of specimens in lab. And again, that's something that's fun to me is a lot of different sources.

Interviewer: Okay, so parasites can live in a lot of different places in the body. I think we tend to think of in the stomach probably most of the time, or a tick on your skin. That's a parasite. So you get the lab sample. What do you call it when the doctor sends it to you?

Kristen: A test order, or we get the order.

Interviewer: Yeah, you get the test order, you put it under your microscope, and you start looking. That's how you find it. You don't conduct some other chemical test or anything like that?

Kristen: There are some chemical tests. One of them is called an ELISA, enzyme-linked immunoassay, and that's a test that uses the specific interaction of an antigen and an antibody. Antigen is a protein that's going to be on the organism's surface somewhere, so the surface of the cell, and then antibodies are produced by animals, humans, specifically matched to that antigen. So we use those antibodies in a controlled environment, and if the specimen has a parasite like Giardia, cryptosporidium, or even Entamoeba histolytica, the test would be positive.

Interviewer: So for those ones that you just mentioned, you use a chemical test. What are some that you just have to use a microscope for?

Kristen: So the less common ones we have to use a microscope because there haven't been tests developed yet for those less common parasites. For example, dientamoeba fragilis, it's a trophozoite that lives in your intestine. Some of the tapeworms they don't have any chemical tests. We have to look at those under the microscope or even macroscopically look at the tapeworm segments to figure out what the patient has.

Interviewer: And when you're looking through that microscope you know what you're looking for. When you see it you're like, "Ding! Ding! Ding! That's it."

Kristen: Yes, because we receive a lot of training on the job and in school, but more so on the job because we're so specialized in the lab. There's a lot of training that we get. So anything that's potentially there, we can identify it.

Interviewer: Yeah. So with this undergraduate degree that you got, medical technologist, it sounds like you get to do some pretty exciting things?

Kristen: Yeah. I really love my career. I think it was one of the best decisions I made to study medical technology. And then I was lucky enough to get hired on ARUP. To me it's the best place to work. They value their employees, there's great benefits, there's tuition reimbursement, and then as a reference lab we receive specimens from all over the United States and so we get to do really specialized work. It's really fun.

Interviewer: And it also sounds like, for your investment in education, you had the four years as opposed to needing to take 10, 12 years of education and you're already helping people.

Kristen: Yeah, I think it was a great return on investment and the major is, and the classes you take, are very hard. It's a very rigorous course no matter what university you go to. But it really pays off because I'm doing something that helps people. It has value in the community and then it's also fascinating.

Interviewer: If somebody was considering this as a career, what would you say to them?

Kristen: I'd say do it.

Interviewer: What kind of person would be a good fit for this?

Kristen: The best fit for someone who wants to work in the lab is someone who likes attention to detail, likes to work with their hands, likes to problem solve. A lot of us are kind of science nerds and so we enjoy being behind the scenes rather than right there with the patient like a nurse or a doctor. We have a really big hand in healthcare. Doctors depend on the results that we give them. We're behind the scenes, though.

Interviewer: Yeah, that must be really rewarding.

Kristen: It is. When I go home every day I feel like I've done something good. I've helped somebody, whether I've seen their face or not.

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The gospel that I am trying to preach is to my colleagues in medicine, understand what's happening, learn the facts, lift up your heads enough to see what's going on around you. Understand the problem and then begin to ask yourselves "What can I do to help?"

When I started out in medicine in 1946 there was no such thing as a health care industry. The term health care industry had never been used. Nobody referred to it as an industry and nobody thought that being a physician was a business. Now we are dealing with the inevitable consequences of a health care system, which changed from a social service to a business. Just as you would predict it ignores more or less those who can't afford to pay. It exploits the opportunities to make money at the expense of the obligation to use resources conservatively in the most effective, medically appropriate way.

It invites all sorts of abuses including fraud and it's clear that it's not working and it can't work because there's a fundamental disconnect between medical care and almost all other economic activities in our society. A patient consulting a physician because they're sick, got injured, worried, or frightened that they may die or become seriously ill is not like an ordinary consumer in an ordinary market and physicians should not be like vendors in an ordinary market. Their objective should not be simply to sell whatever the consumer will buy.

Physicians are in the best position to decide how best to use the resources that we expend on health care. I've outlined what doctors might do if they wanted to. They could form multi-specialty group practices not-for-profit group practices that would be prepared to accept payment on a per capita rather than on a piece work basis, on a per capita basis for comprehensive care. There's no question that that system would work.

The only question is, how do we get it to occur politically in the current political climate? That's a big problem, we're going to have to change the attitude of the public and we're going to have to change the attitude of the legislators. It's issue of survival. We are simply not going to survive with the health care system we have now. It's going to implode. We must do something and doctors could help get it started. At least that's my hope and I think it's not unreasonable.

One of the hopeful aspects of all of this is that pretty soon half of all practicing physicians are going to be women. More and more multi-specialty groups are being formed and women are becoming a very significant part of that movement. I'm expecting that women may save the day.

Some of the most innovative things that we're thinking about right now are something referred to as milestones. So in the residency world, we're being able to now identify exactly where people are along a spectrum of skills in six different areas and with the idea and vision that as people meet those skills we can move them along the pathway and again get rid of the rigid timelines that we're currently married to.

For those of us who have been doing medical education for a long time, we know some people learn faster than others, and other people learn slower. The fact that we're facing a deficit of 90,000 physicians coming up here very soon in the next decade, we really need to be thinking about: How can we turn people out more quickly? How can we ensure that we get people in the pipeline, keep them in the pipeline, and then turn them out at the end?

The thought that keeps me up at night is probably that we're not using people's time effectively. Not just individual people, but thinking about the synergy that gets created when we bring the right people together.

Our universities without the people, the faculty, the staff, the students are really just a collection of buildings and equipment and material supplies. The people who are there are the ones who make all of this work. The faculty are incredibly dedicated people. They've made a commitment beyond just being practitioners within their own field. They've decided to come back and share that knowledge with learners.

I think we've got extraordinary potential, and the thought that we might be wasting any of that really does break my heart.

When you work in an environment like academic medicine, we have so many capable individuals, and you think about what they could do if you could get the right folks at the table at the right time to look at the kinds of problems we're facing. I think the solutions are out there. But we have to talk to each other. We have to build that shared knowledge based. We have to have that ability to catalyze one another's thinking to actually get these problems solved.

There's a saying in the medical school community that when you look at one medical school, you're looking at one school because they're all very unique. I believe that we are all very unique. But I also think that among us we have such common purpose that we really should be thinking about the things where we are catalysts for something together.

It's up to us to think about how to push the frontier about healthcare for people in the United States. So that's not about us just being unique. That's about us using our uniqueness to forge something better and stronger, and I think we've certainly got the capacity to do that.

A role of the leader of the organization can simply be to set a tone that indicates that it's okay to be innovative, it's okay to take risks, and if you are and you have some success, that's going to be recognized. That counts as much as the traditional things in academic medicine.

The models of how we provide healthcare to our patients, how we interact with our patients need to change. Also the models in the way we educate our students need to change. It's been very traditional. Institutions across the decades have changed. Course content has changed the way it's delivered.

But by and large, we're still heavily lecture-based. We should have programs where students can move onto the next subject once they've shown that they're competent in some area, rather than having to finish the semester in that particular class. You know, we're locked into these fixed time scales. Those sorts of models of education need to improve.

Then, also, the learner environment, I think, is also something that suffers from these traditions that we have in medicine. Students pick up a lot of subtle signs about how physicians interact in these environments. Not all of them are good.

There's something called the hidden curriculum, sort of what the students see and hear and experience in addition to what they're actually being taught. Sometimes the messages we're sending in those sorts of learner environments are not the best as well.

The practice of medicine now is very different than what it was when many started their practice of medicine. For some, the feeling is that it's changed for the worse. But if you look at the young students that are coming in who haven't known the previous environment, and the excitement level, and quite honestly, the competency level of the new students coming in is just astounding.

I think that spirit of enthusiasm of a bright future, it's going to be a different future, but it's going to be a bright future. The tools, the power that we have, that hopefully we can harness for the betterment of our patients, is just stronger now than it's ever been in the past.

Socks. Socks. So I went in to have a medical procedure, which everybody needs to have done every five years, and I was told to take off my socks. And I refused, because they really weren't interfering with the procedure they were planning to do. I engaged in a fairly long conversation with the nurse who was adamant that I take my socks off.

So ultimately I didn't take my socks off, but I think that that little parable is indicative of our healthcare system, which is from a clinical perspective totally unable to meet the needs of the customer. It really is focused on the needs of the doctor. So our locations need to be convenient to us, so we can run to our lab and on and on and on.

So one of the first things we're trying to do at Ohio State is to recraft healthcare delivery in a way that actually makes sense, that would be done in any service industry and that focuses on the patient.

There's a great quote by Thomas Edison that I love. "If there's a better way, find it."

I think if you have that approach when you look out in the world, you realize that there's always a better way to do what we're doing now. One of the things that's interesting about being in an academic medical center is that you're not just a healthcare delivery system, you have students, and trainees around, and then of course you have many, many researchers.

It's really in that environment is that you can come up with some of the most creative solutions that we need in healthcare, because you have the brilliance of these researchers, and then you're training students, and trainees who are always questioning "Why do we do things this way? Why can't we do it that way? "

Because we have the resources to answer their questions through our researchers, I think we have the opportunity to create whole new ways of thinking that we never did before.

I'm very motivated when I think there's a vision that seems very clear to me, that requires bringing together people from all different backgrounds, from all different perspectives, and getting them to work together successfully.

The value added comes from different backgrounds, different life experiences, trained in different fields of specialty, creativity. And the great new ideas come at those interfaces.

All of us feel a responsibility to train the next generation of researchers, educators, and healthcare providers. As a result we're not just looking at trying to solve the problems today for tomorrow, but we're looking at trying to solve them for years to come.

My highest hopes for the University of Utah are that we really make a difference to the world, we make people better, and healthier, and happier.

The pieces are already here, the talent is already here, what we really need to be able to do is to allow that talent to flourish, and to provide the overall direction for where we want to go. And then kind of step out, get out of the way, and let everyone move us forward.

To know that individually those people are all doing great things, and they're advancing in their own fields, but by bringing everyone in that room together, and to feel those sparks go off, it's incredibly satisfying.

I do feel a sense of urgency about solving some of these problems. I don't really think it's acceptable to . . . I don't really think it's acceptable that some people don't get the care that they need.

My interaction with the health system is very rich and deep, both as a recipient and someone who offers care to others.

We are in a position where we actually do help people. Sometimes it's one on one. Sometimes it's a very simple thing like holding someone's hand or extending an arm around a shoulder in a really difficult time.

When I started as a nurse, back in the early '70s, children's leukemia, Wilms' tumors, they were almost universally fatal, and now we look to people with these diagnoses to families and young children and we can talk about the hope of being almost always curable, and that is an amazing experience. If we could just deliver that to every single person in this country, just think how strong we would be as a nation.