HCDM 56 Travis Brown | General Pathologist

 

General pathologists serve as the line behind the hospital. They don’t get as much credit for what they do and they are okay with that. Learn all about pathology and the study of diseases with your host, Richard Marn and his guest Dr. Travis Brown. Travis is a General Pathologist at Clinpath Pathology. Learn some insight into their research and what they specifically do. Discover the different types of pathology and what is on the rise. And, know the wrong misconceptions about pathologists and what it takes to become one.

Listen to the podcast here:

A Day In The Life Of A General Pathologist With Dr. Travis Brown

We got another episode and another fantastic guest. It is filled with gems as we dive into this career. This career is a hidden job, its impact is so significant that 70% of all diagnoses funnel through this particular career. It has a great work-life balance, and you are a physician as well. The career we’re going to talk about is a pathologist. I’m going to be talking with Dr. Travis Brown. He is a pathologist in Australia. He’s going to give us his perspective and view of what it’s like to be a pathologist. It’s also applicable in the United States as well. You’re going to find this episode very intriguing and interesting and a lot of interesting stories as well that Dr. Brown shares. If you like what’s going on with this episode, you love this episode, even other episodes, please, write a wonderful comment, that would be so appreciated, or hit that like button for whatever podcast app you’re using. That would be helpful as it brings attention to others about this resource. We’d love to get that from you if you can do that.

Thanks for joining me. We have a very unique guest. My guest is Dr. Travis Brown. He is in Australia. Welcome.

Thank you very much for having me.

Trav, why don’t you introduce yourself.

I’m a Medical Doctor. I’m working in Australia. I’m a General Pathologist. What does that mean? That means that I’ve gone to medical school, was the Junior Doctor for a few years. From there, I trained to specialize in Laboratory Medicine. Before I did that, I wasn’t quite sure what I wanted to do. Straight out from high school, I did Commerce and Computing and was going down the accounting path. I started my PY to become a chartered accountant and thought after two years, that’s not what I want to do. I jumped back and did science and found my way into Medicine. A general pathologist, what does that do? Effectively, we work in chemistry, heme, that’s blood. We work in microbiology, so infections and we work in histology, which is a tissue diagnosis. The general pathologist, that’s what I’m doing at the moment and I enjoying doing it.

We’re going to go dive into that little bit more detail. Let’s go through some quick questions with hopefully, quick answers. To get people a feel of what your profession is like. What are the usual steps to achieve your professional degree and certification?

The main part is, one way or another, you get into medical school. In Australia, there are two paths to that. Either you go directly from high school, you get a score and you’re able to go into a course, undergraduate Medicine. We also have a post-graduate pathway so you can have done any degree that you’re wanting to do and you’ve decided to change your path or even do science and go into Medicine. You use that, take a test, and you get into post-graduate Medicine. Once you’ve done that, you’re in medical school. You learn Medicine to become a doctor.

Once you’re qualified, you’re a junior doctor, an intern, or a resident. You do that for a few years, and you apply for a training program. We have specialty training programs, that can be anesthetics, cardiology, gastroenterology, or pathology is what I went into. It’s normally about a five-year postgraduate procedure. I took a little bit longer because halfway through, I said, I don’t want to be a specialist. I want to be a general specialist. I had to train in a few extra areas, so it took me 6 to 7 years, all of that. I’m enjoying what I’m doing now because I span across a few fields as opposed to being a specialist in one.

Just to give a quick overview. How many years after high school on average to become a pathologist in Australia?

Around about 11 to 12. The challenge with that is trying not to think about that journey. It is overwhelming when people say to someone who’s a 1st year or 2nd year medical student or even a science or health student. It’s going to take you over a decade to get where you’re wanting to be qualified. The challenge with that is, it’s one step at a time. Each time you learn something. The problem is even when you get to the end, the learning hasn’t finished because you’re still learning. We’re still learning all the time. It is an overwhelming number.

Learning never finishes. People are learning all the time. Click To Tweet

What is the best part of your career, Trav?

The best part is the work that we have. The work that comes onto our desk and we look at is interesting. Pathology is the study of disease. For me, as a general pathologist, I get to span across different disease categories. We can go from looking at blood under a film, where it can be someone who has leukemia. You sit there and go down and sub-classify that. You can then go to tissue diagnosis. You can look at things like liver or gastrointestinal or skin disease and say, “This is a BCC or an SCC,” a normal skin cancer or melanoma. You can go and have a phone call about an infection. “This is COVID or this is an infection, or just a bloodborne infection, staph aureus.” The patient is septic and unwell. I find diseases fascinating. It’s something we’ll talk about a bit, where we go back into the history of this and learn our understanding and what we’ve come to. I’ve been able to study disease, and I find that fascinating.

What is your least favorite part of your career?

There are two parts of the least favorite. One is, which happens in every profession, it’s not just health, but being an on-call can sometimes be a bit tough. It depends where you are. I worked a job where I was always on-call. You find that a little bit hard because you never quite switch off. Fortunately, that’s not now. You learn to appreciate having your time off. The other part is when you study disease, sometimes you come across difficult cases that make you sad.

I’ll use an example. We had an MDM, Multi-Disciplinary Meeting. This is where you get a bunch of specialists together to discuss difficult cases. This case was a patient who was a mother giving birth, had a cesarean section. They noticed an ovarian mass at the time of cesarean section, and they thought, “This is odd.” They took a biopsy of it. It turns out it was malignant cancer. You sit there and this is a discussion that took a long time to work out what it was because it was such an unusual presentation and what we call an incidentaloma. It’s something that was out of the ordinary. You sit there and go, “Here’s a new mother with a baby that’s been given a terrible diagnosis.” I found that hard. You move on to then the next case, which was a 30-year-old male who had malignant cancer, melanoma all through their body. I find that hard. There’s no redeeming factor. This isn’t a look at the positive, no. Sometimes things happen and it’s hard. That part of things you need to make sure you have a life outside to be able to manage that.

What are three highlights of your profession that people should know?

One is the job, we were hidden. Pathology is hidden. The challenge with that is we’re the line behind the hospital. The highlight is 70% of decisions in medicine are based on pathology results. A hundred percent of cancer diagnoses are made through pathology. The impact is significant that we make and we’re not thought about. That’s okay. People often aren’t worried about that. It’s a highlight because we are integral to the medical care of patients. The highlight is work-life balance. I’m able to work a 9:00 to 5:00 job, maybe a little bit more, plus or minus on-call.

From that, it’s enjoyable because I still get to drop my kids off or pick them up from school, if needed. I also get to run at lunchtime. The work-life balance is enjoyable. The colleagues, pathologists are great. There’s a path with a community, people sharing cases and asking questions, which is collegial. It’s worldwide and you can jump on there and see all these pictures, “Look at this case.” People put on Twitter, they call it tweetorials and it’s, “What do you think of this case?” It’s an enjoyable welcoming community. It certainly doesn’t have the stigma that Twitter can have. That would be the highlight.

Those numbers that you highlighted, I never thought of it that way, but yes, pathology is integral for making decisions in the decision tree of how to care for that patient.

HCDM 56 Travis Brown | General Pathologist

General Pathologist: The most impactful thing you can do when you start a new job is to learn people’s names. If you know their name you can talk to them and ask for help from them.

 

In the worst possible way, COVID has certainly highlighted the role of pathology has in the testing. It’s one of those things, we’re testing those numbers, a swab up someone’s nose. It’s a test in something that a disease didn’t exist before. We’ve gone from that to be able to test to find out where it is to isolate. That’s just one disease. You talk about all these other diseases that are going along, we’re still diagnosing. It certainly comes to the forefront.

All those samples go to a pathology lab. That’s amazing how we’re hearing how pathologists have an integral aspect and impact on people unbeknownst to them. I know you mentioned all these different aspects of pathology, that you deal with hematology, for example. What’s a typical day like? Start to finish.

Start to finish with work, I typically do chemistry validations in the morning. A lot of chemistry is automated. When we talk about chemistry, if you go and have a blood test and you’re talking about how my kidneys functioning or how’s my liver functioning, there are liver function tests and renal function tests. You take some blood and we see what chemical composition of that is. That’s a chemistry test. Several years ago, we’ve gone from where they used to do a few hundred a day to hundreds of thousands of tests per day. There’s no way anyone could sit there and go, “This is a valid result.” 95% to 98% of chemistry results are automated, comes in, goes out, it’s fine. There’s a small percentage that may be a bit odd or doesn’t fit our rules. They need to be validated by a pathologist. It’s not a huge percentage, but you can get a 50%, 60% that doesn’t quite fit the rules. We go through and make sure they’re okay to be sent out. If there’s something odd, we raise it and say, “That doesn’t fit.”

Depending on the day, I might look at a few blood films. These are patients, same parameters with blood, “Is this patient anemic or not?” You look at the blood film why are they are not, is there something unusual happening? I’ll move from that. Sometimes you’ll get calls from microbiology about inquiries like, “I’ve got an unusual bag in a blood culture. What do I do with it? Is it important? Is it not?” Most of the afternoon, I’m reporting skins. Looking at them as skin cancer. Sometimes inflammatory skins but normally I pass them on to the dermatopathologist because it’s a specialized area. That mainly consists of my day of reporting. I am fortunate. A lot of the times, people at specialist areas will just do that one area. I also have them at my back when I’ve got something that is unusual, that I’m not sure yet.

They confer with and collaborate with. Trav, what you do day to day? You look at tons of slides. Do you have one to show?

The readers won’t be able to see it, but here’s a skin slide. On your arm, you’ve got a mole and it starts to spread. The GP or a surgeon will look at it, say, “I’m worried about it. Let’s cut it out.” They’ll look at it. I’ll give you some anesthetic and they’ll cut a little ellipse. The reason why it’s an ellipse is because our collagen fibers are all in one area, so they cut it that way so when they close it up, it’s a nice clean scar. That’s the reason. When they then send it to us in formalin, that fixes it. What does that mean? It means the chemistry holds it together, so when we cut it up and process it, we can see it properly. Otherwise, if you just leave it, it degrades and then we can’t tell anything about it.

Your eyes are very important obviously, in this career. You got to have a look. You have to know what’s normal, what’s abnormal. You’re looking at microscopes and slides on a day-to-day basis.

Pathology is hidden. It's the line behind the hospital. Click To Tweet

We now have digital pathology. That’s moving probably from the microscope to images online, on your computer. One area of pathology, we call anatomical pathology and histology. That’s primarily microscopes and looking at tissue. There are areas where it’s not but it’s one of those. You will be looking down the microscope most of that time in histology.

Trav, by the way, what are some misconceptions people have about your career?

The main one is that either pathologists are boring. Pathologists are bookworms.

That’s like anesthesiologists.

It’s like the classic dungeon. You’ve got to go to a hospital where they put the pathology department in the basement where there are no windows and extraction fans. Pathologists are some of the most balanced individuals. They enjoy work and work hard. The balance with that is getting qualified in anything. Unfortunately, in medicine, there’s a bit of a trade-off. The sacrifice to get there takes a lot of study. That’s the biggest misconception about pathology, is that people are boring. They’re bookworms, anti-social almost. I’ve found it anything other than that.

This episode is a perfect example, breaking that misconception by talking with you. Let’s talk a little bit about the outlook of the profession for a pathologist. We mentioned digital pathology, but what do you think the future outlook is like for pathology as a field?

It’s good. The area that’s going to explode in pathology is called molecular pathology. What we currently do in pathology in general, it’s age-old techniques about identifying tissue. This is hundreds of years old. We’re looking at the same stuff. You could take the pathology, put it back several years and essentially, it hasn’t changed much from looking at slides. We’ve done immunohistochemistry, which we treat it with chemicals to say, “Are you something like this?” It says, “Yes or no.” What’s happening now is you have personalized medicine.

That is where people have a tumor, like melanoma, lung cancer, or colorectal cancer. We will take it out of the person and do molecular pathology on that. What that means is we all see the tumor signature of it. From there, we’ll know, “This drug won’t work, but this drug would work well.” What they talk about is personalized medicine. We say, “This tumor has this signature. Now that’s about to explode. In the next 15 years, you will not just have cancer, you will have cancer that has this signature. Therefore, we’re going to treat it with this drug because we know these other drugs are going to be toxic and you don’t get any effect.” That’s one strand of pathology.

HCDM 56 Travis Brown | General Pathologist

General Pathologist: 70% of decisions in medicine are based on pathology results. Pathologists are really integral to the medical care of patients.

 

The challenge for pathologist is keeping up to date. That’s the balance. Will it change? Yes. People who have been practicing for 20 or 30 years, now have to come to grips with a new field of RK. We have to do this molecular test. The challenge for pathology is making that information accessible. Not just to clinicians because that’s almost clinicians’ job but also making it accessible to people to understand this is what needs to happen here. It’s an exciting time, but it’s also a challenging time because we now have so much information to pass on. We have to work out how best to pass that on. I don’t think we’re there yet, but it’s an exciting challenge for the future.

I can feel that blowing up and how that could be so impactful for a lot of people.

They’ve shown evidence of the last several years, specific treatments of melanoma. Some people who have metastatic disease all throughout have this treatment, and it shrinks the tumor. It’s not a cure, it’s a management. They get something from a terminal diagnosis of 4 or 5 months to a year or two, that will be significant for someone who’s been given a terminal diagnosis. We’re only going to get better and progress further. Trying to understand that and learn all about it is also a challenge.

Trav, what kind of students you think best match and do well as a pathologist?

The main ones are people who enjoy study. If you are a person who loves the outdoors and needs to burn off energy and everything, it doesn’t work well. It’s one of those ones because you need to be able to enjoy study, find the enjoyment in learning things because there is so much to learn. If you’re a person who loves to build a shack and build a fence or anything like that, pathology is probably not going to be something you enjoy because you need to learn and memorize textbooks, unfortunately. That can be a challenge. The other part is visual memory.

That’s not essential because some parts of pathology don’t require looking at multiple images. If you have a visual memory, it’s as simple as, how does someone even know the differences between a Lamborghini and a Ferrari? That’s looks different. That’s what pathology is, then the microscope. This cancer looks different from this cancer. If you can do pattern recognition, then it’s useful. If you enjoy study, then you consider pathology because you get to do a fair bit of study. It’s an interesting study, why does this disease behave like this? We know the prognosis of the patient. This is the path they’re going to go down.

By the way, I did want to ask. I know this is not part of the future outlook of your profession, Trav. As a pathologist, do you ever talk to patients directly?

We don’t so much in Australia, but I do know you in the US they do. We tend to be the doctor requesting our services and we send a report to them. Whereas in the US, my understanding is the information is sent to the patient as well. They do have consultations. If you’re in hematology, yes. Your half job will be some lab and some clinical. Microbiology may or may not because they might do rounds with the infectious disease people. It depends, but we tend not to in Australia. We tend to be a little bit more, “Here’s the report for the doctor.” The main part of that is because we know a lot of information can be misinterpreted. It’s starting to change a little bit because we now have health records, which will go directly to the patients. It will be important for us to probably be ready for patients to contact us, but we tend not to get direct contact from patients.

I’m changing the topic here. I want to talk a little bit about you. How did you become a pathologist? Even before that, you mentioned you were in accounting, which by the way is not in medicine at all. You were doing something else. You had another profession as well if I recall. You were working at a Mars confectionery. You were a factory worker.

The biggest misconception about pathologists is that they’re boring. On the contrary, they’re the most balanced individuals in the business. Click To Tweet

During my studies, I worked at Mars confectionery. That was packing boxes. I’ll be honest, when I was in high school, I didn’t know what I wanted to do. As far as I was concerned, I was going to play basketball. I liked to talent. I was at the point where basketball was eating a bit for life. It’s hard when you’re in year ten over here, a few years away from finishing high school. When people ask, “What do you want to do?” It’s like, “I don’t know but I want to play basketball.” As far as I was concerned, I was going to go to Duke University. Coach K, he’s retired now. I’ll have to see who the next one is.

I clearly didn’t have a good grasp of reality at that point in time either. It was like, “What do you want to do?” I wasn’t quite sure. In year twelve, I ended up falling into Commerce and Computing. Mainly because I initially thought physio. If I enjoy sport, maybe physio is the way to go and then I thought, “I don’t want to be around sport my entire life.” What happens if your hobby becomes your work? Will those worlds collide? As flimsy as it is, I went and did computing because I enjoyed computer games. It sounds ridiculous now, but that’s what I did.

To be honest, I learned how to learn in university. I was like, “I need to remember these things for the exam.” That’s what we do. I ended up finishing that and going into accounting. That’s when I was in my mid-twenties, when I asked the question, “What do I want to do?” Where I thought, when you’re working 60 hours, I don’t want to be pushing paper for my entire life. Numbers that don’t mean anything to me. I went back to do health. That was my rationality. I found my brain about mid-twenties. That’s when I was like, “I need to learn these things to know something. That is useful.”

No education is lost. If you don’t know what you want to do, go broad, learn something, you will always end up using it at some point in time as well. I’m still using my computing at the moment. I’m still programming. It could be because things in pathology need programming. That’s useful, but it’s a bit of a hopscotch way to get where I got. I envy people who said at 16 or 17, “I want to be a doctor.” They had the drive to go there. “I want to be a lawyer.” That wasn’t me. I didn’t know what I wanted to do. I’m pleased I’ve gotten to where I am. I probably wouldn’t be here if I didn’t take that path.

I went through a few things. I’ve worked in a factory. I’ve seen chocolates, packed boxes at 3:00 in the morning. I wanted to cry at that point. It’s the first time in my life when I could understand people smoking because you sit there and it keeps you awake. It keeps you focused during mundane tasks. I probably would’ve smoked at 4:00 in the morning but no. I’ve gone through a number of jobs. There was one thing that I found, the single most useful advice I could give to anyone. If you’re about to start a job or learn a job, when you go in there, the most important thing for you to do is learn people’s name. When you go in and your whole focus is trying to remember people’s names, you get a bit of a grace period. People Jr., People Sr., if you learn their names, you can ask for help. You can talk to them. The most impactful thing I’ve done is learning people’s names when I started the new job. For no other reason than when you need help because you always need help. To ask them directly is something that they turn, “He remembered my name.” It’s such a personal connection that it helps.

That’s great advice. When you were transitioning to your health career. How did you choose pathology versus all the other options? What was the decision-making process there?

When everyone think of medicine, they think of the glory specialties, like cardiology, neurosurgery, emergency medicine. Pathology is genuinely hidden. I always enjoyed studying pathology during medicine. The reason is because it helped me understand the disease. If I didn’t know why did this disease happen, you’d go to the pathology and book and say, “All this inflammation causes a transition and then it becomes malignant.” You’re like, “Now, I know.” It wasn’t until I was a junior doctor when you’re running around, you’re just trying to get things done in the hospital and you’d go to these multidisciplinary Meetings and the pathologist would either walk in with a coffee with his slide tray or they are already there or they were a bit late.

HCDM 56 Travis Brown | General Pathologist

General Pathologist: Pathology hasn’t changed much over the years. But with molecular pathology, you’re working with personalized medicine.

 

I would sit down and what they said was critically important to the management of the patient. They also seem relaxed, they were nice to chat to, and they weren’t rushed. They were very kind. Even if you showed interest, they said, “Come back and have a look at a few things,” or you would go into the department and they would say, “Show these interesting cases.” They were so approachable. You’d go back to the ward where you were literally running around trying to get a CT, MRI, or IV fluids, the surgeon downstairs needs this and you were trying to get things done. It was difficult.

You had this other department where people were relaxed, they were kind. The more I looked into it, the more it made sense. The first few years of studying, I enjoyed the academic side of medicine but then I found the ward stressful. I found not the challenge because once they get in from ED, whether an undifferentiated patient or they’ve gone to cardiology, they’ve got a cardiology problem or a neurosurgical problem. It’s not just trying to work out what’s going on. It is trying to make sure that what needs to happen happens. Whereas what lands on my desk is, “What is this condition? What is this disease? What is this malignancy? What is this skin rash?” My job is primarily diagnostic. We have enjoyable people that we work with and it’s primarily, “What is this?”

That is some great pearls of wisdom and highlights about your career. Thanks for sharing, Trav.

Thank you.

I want to go through my Rapid-fire questions. A little bit of quick questions, not usually medicine or healthcare related but I would love to hear your answers. Toilet paper, over or under?

Over because when I was a child, I heard that over is meant to be more pleasing, aesthetically.

What’s the most beautiful place you’ve ever been?

I’d have to go Halls Gap. That’s because when you camp, you see the sun come up. You’re in a valley and you see the sun go over.

Where is it?

In Victoria, and you’ve got kangaroos coming around. There was one that almost into our cabin. It was a little bit unsettling. It’s beautiful.

Where do you want to go more than any other place in the world that you haven’t been to?

I wanted to go to Europe and some of the areas of Germany. I want to experience Germany, Italy, France, and Spain. I want to see the history. I love reading about history.

No education is lost. You'll always end up using it at some point in your life. Click To Tweet

What’s your favorite restaurant?

At the moment, we’ve got Windy Point up here, which is just a beautiful restaurant with a view of Adelaide. That’s something your readers will know about, but if you come to Adelaide, Windy Point.

That’s the place. We’ll put that in our recommendations. Trav, where can the readers go to find out more about you and see what you’re doing?

We have podcasts that we do. That’s called This Pathological Life. This is about the history of pathology and medicine. This is about our evolution of understanding and from what we thought a disease was to what we know now. I have guests on intermittently who are specialists in their field but it goes from everywhere from endometriosis, prostate cancer, to smoking, alcohol, drugs of addiction, and mesothelioma. What is the history behind that? I love doing that. That’s in any podcasting service or Spotify, search for This Pathological Life, that will come up. We’re on Twitter, @DrTravisBrown, you can connect with me through that. Also, on LinkedIn, Travis Brown. We have a few This Pathological Life as well but I often share short stories on there. That’s probably either going to be on the podcast or not enough to go on. I put information on there. LinkedIn is podcast base medium which I go through. Instagram, that tends to be the main images that we put up for the podcast. That’s @DrTravisBrown.

You have this website, right?

Yes, PathNotes.com.au, this is literally my notes of studying pathology. It will go somewhere one day. This is my thought bubble when we have to know so much but I couldn’t remember it all. My aim will be, at one point in time, to get this to www.PathNotes.com.au. You have a link at the bottom of a report that says, “Here’s more to know about atypical fiber exanthema,” which you sit there going, “What is this?” GPs wouldn’t know that. “Here’s the information, here’s what it is, and here’s what you do with it.” This is my notes. We’ll see. It might or might not.

Trav, this is great information. I appreciate you coming on. Thank you so much for sharing.

Thank you very much, Richard. Thank you for your readers’ time. I appreciate it. It’s been great.

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About Dr. Travis Brown

Dr. Travis Brown is a General Pathologist who enjoys working in the fields of Biochemistry, Microbiology, Anatomical Pathology, and Haematology.

Travis enjoys the diversity that General Pathology provides with being able to work across multiple disciplines in pathology.

He is the medical researcher, writer, storyteller and voice of This Pathological Life Podcast.

He is well known across the Adelaide medical landscape for his ability to quickly summarise key points and frequently asked questions in pathology for general medical practitioners and specialists alike.

His background in Anatomical Pathology, started in 2010. He worked as a Registrar with Dorevitch Pathology and the Royal Melbourne Hospital.

After he completed the Part 1 in Anatomical Pathology, he transferred to General Pathology with Healthscope (now Australian Clinical Labs), where he worked for 3 years as the Supervising Pathologist for their Adelaide and South Australian Regional Laboratories.

Prior to studying medicine and receiving a Bachelor of Science (Medical Sciences), Travis completed a Bachelor of Commerce/Bachelor of Computing and worked for two years with PricewaterhouseCoopers in Melbourne for the Global Risk Management Services (Information Technology) department. His personal project, www.pathnotes.com.au comes from his interest in IT, Pathology Informatics as well as Structured Reporting.