Blood, Sweat and Smears - A Machaon Diagnostics Podcast
Blood, Sweat and Smears is a podcast focused on thrombosis and hemostasis and is hosted by Benign Hematologist, Dr. Brad Lewis. Dr. Lewis shares some of his knowledge built over decades of experience in hematology and laboratory testing.
Blood, Sweat and Smears - A Machaon Diagnostics Podcast
5 Questions with Dr. James Malone
5 Questions is a new series of Blood, Sweat and Smears, hosted by our Senior Director, Bjorn Stromsness, who asks 5 questions to physicians in and around the disease areas we work in.
In this episode, we are joined by Clinical Associate Professor of Hematology at Stanford Medicine, Dr. James Malone, Colonel and Command Surgeon of the U.S. Army Reserves.
Hello and welcome to Blood, Sweat, and Smears, your Maecheon Diagnostics podcast with tag team hosts, including our medical director, Dr. Brad Lewis, Senior Director Bjorn Stromsis, that's me, and other guest hosts. We hope you find these podcasts interesting and informative. Thank you for listening, and away we go. Hi, my name is Bjorn, continuing our series Five Questions, posing five questions to physicians in and around the disease areas we work in. Today we are joined by Dr. James Malone, Clinical Associate Professor of Hematology at Stanford Medicine. That's right, straight on classical hematology. We are also joined by Colonel and Command Surgeon James Malone of the U.S. Army Reserves. Huah, and thanks for joining us today, Dr. Malone.
SPEAKER_00:Mega Hua to you, Bjorn. Thanks for having me honored and pleasured to spend some time with you and uh and answer a few questions, hopefully, that are of interest to our mutual audience.
SPEAKER_01:Okay, on to our first question. I know you've done a shift in hospital administration in your career, and I'm wondering how being a physician informed how you approached your work as an administrator.
SPEAKER_00:No, thanks for asking that question. It's increasingly a common career path or way to blend both sides. I learned a lot about leading small teams and leading hospitals in the Army and found it a natural transition to blend what I did in hematology with what happens in the hospital and healthcare system. You know, one of the things that I found was key was to continue to do both things. It's challenging to do that. You know, when one becomes a chief medical officer of an acute care hospital, the bandwidth of time to then being an active clinician still diminishes greatly. But I found it was really important to be present clinically to your colleagues in order to be able to influence what they do and don't do relative to hop operations, quality and safety and service. So I never stopped being a clinician, mostly because of that, also because of just pure love for hematology. I can't imagine giving it up in any fashion.
SPEAKER_01:That's what we like to hear. So, second question is how did your time as an administrator inform your work as a practicing hematologist?
SPEAKER_00:That's also a great question. You know, when we train residents and fellows, we always focus on things that we call systems-based practice. And that really means how well does one understand and use all of the tools of healthcare? You don't really understand and learn that until you start dipping your toes into the operation side of how healthcare runs, and particularly a hospital. So I spent countless hours in every department of a hospital understanding how they work together and how they don't work together. And one of the things I really learned, and this was cemented home during COVID, is that people didn't understand how the laboratory works and how important laboratory medicine is, how useful it can be, how much it can be misunderstood and misused and misunderstood. So I really became a much better clinician and particularly able to train the next generation of hematologists by really understanding how a hospital works as an organism. And that's really how I how I see a hospital. It's no different than the human being. It's got all these different departments or organs that work together, hopefully, sometimes don't. And the better we understand its strengths and weaknesses, the more we can help others do the same. So those two have really gone hand in hand.
SPEAKER_01:And we didn't pay you to hype up the lab there.
SPEAKER_00:So just so everyone knows that. No, negative. I've I've always told everybody I'm a I'm a laboratory professional at heart. You know, a good portion of my early career at Stanford was as the associate director of the Blood Bank and Transfusion Service as well as Special Coag Lab. So I've always been a kind of half clinician, half clinical laboratory uh specialist, and always always tell everybody I work with that's often where my heart lives. Fantastic.
SPEAKER_01:Yeah. All right. Third question. So you split your time between Stanford and the U.S. Army. And what do you experience as the strengths of those two, and I'm assuming here, very different worlds?
SPEAKER_00:Yeah, it's an interesting shift. I was, you know, just recently over in an area that the Army has a big role in, which is called Central Command or CENTCOM, which is the traditionally what people know is the Middle East, basically being a chief medical officer there or Army healthcare assets. And people might think that there's not really any parallels, but really the day-to-day key tasks and skill sets are exactly the same. You have to understand how complex systems work. You have to be able to lead small teams, you have to be able to know what your mission is and what your desired end state and goals are. Otherwise, you can really get lost out there and put in a lot of effort, a lot of work, and not accomplish a lot. So I think really the the key things that tie the two together are the importance of teamwork and particularly in person. This world of remoteness that you and I are doing right now is great for a lot of things, but there's nothing that substitutes for just being in the trenches with each other. And that's the same whether I'm over there in the desert or whether I'm on the inpatient consult service at Stanford. It's being present to develop relationships, to lead teams is the thing that you need to develop acutely to be able to succeed in either of those realms.
SPEAKER_01:Great. We recently were able to assist in a case you had while deployed. Can you share any of that experience?
SPEAKER_00:Yeah, I sure can. You know, the I can say my 30 years in the Army, I've probably been used as a hematologist less than a handful of times. People always ask me when I show up at a at a new base or a new location, well, hey, sir, what's your specialty? And I joke around, I say combat hematology is what I do. And once in a while I do get called for that. So in the midst of the conflict and the war between Iran and Israel recently, I was notified that one of our U.S. service members was gravely ill in a civilian hospital in the Middle East. And it just so happened that everything I was told over the phone made it sound like a typical HUS or TMA that was going on. So right when uh the conflict ended, six hours after that, I was on a plane to the country where this soldier was to go to the bedside and help diagnose what was what was happening. And it was really clear to me that that this poor individual had a severe life-threatening thrombotic microangiopathy, and it wasn't clear why this was. I spent a few days ruling out the things that I could rule out there, but then the thought came to mind that geez, I think I I need some special teams players. And of course, you know, Mechian diagnostics came to mind of helping me understand that this this gentleman have an inherited tendency to develop this problem. And uh I was able to draw blood specimens from him and Bjorn, with your and your team's help, able to rapidly get a TMA genetic panel done, which was very instructive in telling us that yes, indeed, this individual had a known risk factor for developing this problem and we had the right diagnosis. Unfortunately, despite all of our best efforts, he he died of his underlying illness. But it was critical to be able to tell his family, and particularly his one surviving brother, why we thought his 26-year-old brother slash son died of illness uh while on active duty in the service of his country, and to be also share with them that, yeah, there is a genetic predilection that we should pay attention to for his brother and also other members of the extended family. So it was it was critical to be able to have that worldwide reach of the expertise and talent that Mechan presents. And I'm forever thankful to be able to just reach out to you and your team by any means necessary and get that assistance.
SPEAKER_01:Well, we were very honored to play a small role. All right, our fifth question classical hematology often doesn't get the respect it deserves. So, what would your elevator pitch be for your subspecialty?
SPEAKER_00:I would ask the person in the elevator, tell me the most common laboratory test ordered in the United States annually. And I bet you, even if they didn't know, they could guess. It's a CBC, right? So, therefore, there's so many opportunities for classical hematology to get involved in the care of just about any patient because routinely you're gonna find some abnormality there that needs some explanation and understanding, and that's often the window into so many other disorders and diseases that the patient has. So it's it's again, it's something that every practitioner looks at regularly in their patients, but understands often the least. The other pitch I would give them is that we are about the busiest consult service in the hospital. We routinely carry over 20 patients on our inpatient consult service, ranging from labor and delivery to the emergency department, cardiac ICU, pre-op surgical area, medical teams, solid organ transplant, and bone marrow transplant. There's no corner of patient care where classical hematology doesn't touch. And we're a huge enabler of all these other important life-saving services. We're constantly trying to tell Stanford Medicine how important we are. Of course, we pat ourselves on the back every day and try to share with them our impact. But really, classical hematology and systems-based hematology is critical to the ability to run tertiary and quaternary care centers. It's not possible to do it without expertise on site. And that also includes expertise in laboratory diagnostic services.
SPEAKER_01:Fantastic. So if you're keeping score at home, that is five questions, which brings us to our bonus question. And that is what is something you'd recommend? And it can be absolutely anything.
SPEAKER_00:Do things occasionally that are way outside your comfort zone. One of the sayings I heard a long time ago that I try to subscribe to is you know, life begins at the end of your comfort zone. I constantly try to put myself in little situations that are not particularly of high risk to myself or others, but that make me uncomfortable. Because it's only when I do that that I start to learn about myself, about others, and about the world. So I would say get out there, get a little bit uncomfortable, and you'll actually be better off because of it.
SPEAKER_01:Yeah, it's great advice. Uh, and while this conversation was well within my comfort zone, I'll look for an opportunity here shortly to get outside of it. Thank you very much for your time today, Dr. Malone. Really appreciated your comments and your words.
SPEAKER_00:I'll just say in closing, you know, one of the things that I think we have in common in the Army and your team has in common with us is our approach to our work. You know, we always say mission first, people always. But that's also the same approach that you and your team take to your work.
SPEAKER_01:Very much appreciate it. Thank you very much.
SPEAKER_00:Absolutely.
SPEAKER_01:That's it for us here at Blood, Sweat and Smears, a podcast produced by Machion Diagnostics, your reference lab and CRO specializing in thrombosis, hemostasis, and rare disease. Thank you for listening. And if you have a question or comment or there's a topic you'd like Dr. Lewis to speak to, please send us an email to BloodSweat and Smears at Machion Diagnostics.com. That's M-A-C-H-A-O-N diagnostics.com. You can follow Maecheon at Twitter at Machion DX. Be sure to subscribe to stay in the know. Share this podcast with clinicians you think might appreciate it, and we hope you'll join us next time here at Blood Sweat and Smears.