Chemical pathology is the study and diagnosis of diseases through the analysis of biochemical substances in bodily fluids, such as blood, urine and cerebrospinal fluid. This field focuses on understanding how chemical imbalances, metabolic disorders, andmolecular changes relate to various health conditions.
Dr Samarina Musaad is a chemical pathologist and an ambassador for Pathology Awareness Aotearoa. We asked Dr Musaad about her role as a chemical pathologist and the impact of point of care testing (POCT).
(Point of care testing (POCT) refers to medical diagnostic tests conducted at or near the site of patient care, outside of the laboratory.)
What inspired you to pursue a career in chemical pathology?
I liked the idea of looking into the actual causation of disease, which is what pathology is all about. Linking an abnormal chemical biological pathway or abnormal levels of biological marker/s to a patient’s symptoms, or even connecting a chemical abnormality to a potential future illness (prognostication), is very interesting. What we discover in pathology laboratories forms the foundation of medicine and medical treatment.
How has your experience influenced your approach to healthcare?
It showed me that healthcare is very complex and multidimensional. While bureaucracy may appreciate splitting healthcare into silos, functionally, we are all one single unit. Patient-facing clinicians, nurses, pathologists, scientists, managers, and allied health professionals are all important in different ways.
What are the most common misconceptions about the work of a chemical pathologist?
That they don’t exist! Or that all we do is look at reference intervals.
Some pathology specialties are easy to quantify in terms of workload, such as how many slides were reported. In chemical pathology, we do report certain tests in a quantifiable manner, but overall, using quantity to know what we do is harder than in other pathology specialties. We do a lot of data crunching, evidence seeking through literature searches, laboratory investigations for example, when investigating an analytical interference, risk management, reporting of complex and esoteric test results, discussions with clinical teams, detailed verification of tests, ongoing quality and process improvement, matching reference ranges and assay performance to local populations and their need.
A Chemical Pathologist is like salt in food; if they are there, all is well, and their presence may not be noticed. But if they are not, all falls apart!
What do you find most rewarding about your work in chemical pathology?
Machines and technology provide data. Chemical pathologists transform this data into information that makes sense. The ability to transform this information can only come with (1) clinical knowledge, (2) knowledge of the pathology of disease and (3) knowledge of analytical techniques in medical laboratory testing. A chemical pathologist, through their medical training and specialisation in pathology and analytical methods, connects all these dots. This is most rewarding.
How do you believe point-of-care testing enhances patient care?
It takes testing to the patient and provides on-the-spot results. These two qualities are loaded!
We have POCT in hospitals, but the patient may be at home or their GP surgery or pharmacy, where doing a POCT test may mean the patient doesn’t need to go to a collection centre. Knowing the result there and then can mean reassurance, patient empowerment, and even management outside the hospital within the patient’s community. Because POCT uses a small amount of blood and even finger pricks at times, it is beneficial when access to a vein is difficult, and to minimise the amount of blood drawn.
In an era when governments are taking equity of access and health outcomes seriously, POCT is an invaluable tool. We have known this in the pathology sector for a long time, but policies are just catching up. The very important role of pathology laboratory staff in POCT is clinical governance, to ensure best patient outcomes.
How do you see the role of chemical pathologists evolving with advancements in technology?
Chemical pathologists bridge the gap between technical, scientific, medical lab testing and patient-facing clinical care. There will always be the need for that “bridge”. The question is, what will this bridge look like when the two ends of the bridge change? We will evolve with time!
For example, many of the older generations of pathologists did not see the value or a place for POCT; their view was that testing belongs in the lab. Now, in New Zealand pathologists are leading POCT, and work with other specialities to streamline clinical pathways using POCT. We also work in rural projects and with Government to use POCT as the pro-equity tool that it is. We will also lead change as we do. We are becoming more involved in supporting the safety of direct-to-consumer testing and the impact of AI in the sector.
Dr Samarina Musaad is an ambassador for Pathology Awareness Aotearoa. She is a Chemical Pathologist and Clinical Director for Chemical Pathology and Point of Care Testing (POCT) at Te Toka Tumai Auckland District.
