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In praise of the path less traveled: public health labs

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Jan Bowers

July 2016—For those who crave variety in their work and have a penchant for the unusual, Paul Bachner, MD, has a career message: Don’t overlook public health.

Dr. Bachner

Dr. Bachner

As medical director of the Division of Laboratory Services for Kentucky’s public health department from 2013 to July 2015, Dr. Bachner expected the unexpected, whether it was an outbreak of food contamination, a suspected case of Ebola, or a newborn with a life-threatening metabolic disorder. “We would begin the day with a meeting of all the supervisors of laboratory sections and talk about what kind of testing we were doing that’s out of the ordinary,” says Dr. Bachner, who is now a consultant to the health department. “For example, we may have been informed by our colleagues in epidemiology that there was a Salmonella outbreak in a particular county; we needed to confirm that, identify the strain, and track down the source. We had alerts involving tuberculosis within the past year.”

Although the state laboratory is not routinely staffed at night, Dr. Bachner says they’re prepared to test at any time for agents of potential bioterrorism, always with more than one person present. “We periodically have a white powder event, in which a suspicious-looking substance is sent to someone in government,” he says. “More often than not, it turns out to be talcum.”

Dr. Bachner is a professor of pathology and laboratory medicine, University of Kentucky, and director of laboratories at UK HealthCare. Three years ago, the state contracted with the university to provide a director of laboratory services, an arrangement Dr. Bachner calls uncommon. “Public health is a wonderful career path, but I believe one of the reasons the state was interested in having us provide the directorship is that it’s difficult to find pathologists who know about this opportunity.”

(C. Darrell Jennings, MD, chair of pathology at UK, and Julie Ribes, MD, PhD, UK professor and director of clinical microbiology, UK HealthCare, served with Dr. Bachner as associate directors and are now consultants. Jeremy Hart, MD, an assistant professor of pathology and laboratory medicine at UK, is now the medical director. “He’s doing a great job with many complex issues,” Dr. Bachner says, “not least of which has been to implement a test for Zika in record time.”)

Much of what public health laboratories do is related to microbiology, Dr. Bachner notes. “But there is also the environmental testing and newborn screening, a scientifically fascinating and complex field that is transforming from a biochemically based science to one that is molecular testing based.”

The evolution of newborn screening was responsible in part for drawing an anatomic pathologist out of private practice and into the public health arena more than a dozen years ago. Stephanie Mayfield Gibson, MD, who would eventually become the first woman and the first African-American to serve as Kentucky’s commissioner of public health, fully intended to turn down an unsolicited offer to become director of the state’s public health laboratory. “I got the call from the former commissioner of public health,” she recalls. “I drove out to meet him, out of respect, to tell him no. When I got there, he said, ‘There’s something exciting going on here.’ And he sold me on the mission.”

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