September 28, 2016

“Hug a Microbiologist”

I read the SGH Department of Microbiology’s official blog’s post on Candida auris and marvelled at the extent of quality control that was portrayed and was also implicit in the identification of the yeast – twice, identifications thrown up by biochemical tests (API20) and the machine “black box” VITEK 2 were rejected by conscientious laboratory staff, who went on to perform ITS sequencing before finally concluding that the organism was C. auris. The process was laborious and would have cost far beyond the price of a simple blood culture. In a profit-driven clinical laboratory, this would have been unthinkable. In the hands of less experienced laboratory technicians and less finicky/experienced microbiologists, the process might have been aborted way earlier. Even as we move towards more sophisticated technologies that rely less on the experience and skill of microbiology laboratory staff (think maldi-tof and automated PCR- or sequencing-based testing), it is good to take the opportunity to appreciate high quality meticulous work. Amusing experiments have shown that the majority of us – even so-called experts – cannot distinguish fine wine from plonk, good bedside manners are often mistakenly conflated with good clinical acumen, and therefore I suspect that the even more esoteric area of quality clinical microbiology work is far harder to appreciate.

Infectious disease (ID) physicians have to work far more closely with clinical microbiologists compared to other specialists. In several countries, ID physicians and microbiologists are sometimes the same persons (although I tend to think this has its own downsides), but the extremely stringent requirements in the Singapore setting has meant that no single person here has been accredited to practise both as an ID physician and a microbiologist to date. Now that I have moved around several public and private hospitals, including experiencing some of those overseas, I can safely say that while good microbiologists are not uncommon, good and experienced laboratory technicians are rare, and great microbiologists as well as great laboratory technicians are like hen’s teeth and are potentially near extinction. Treasure them while they are still around.

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