By - February 25, 2022
This article is part of a series spotlighting Black leaders in pathology and laboratory medicine.
The concept that pathology and laboratory medicine are the bedrock and last word of healthcare for patients has always resonated with Kisha Mitchell Richards, MD, FASCP. It’s what drives both her personal and professional legacy, and encourages her to own her role as a clinician. Dr. Richards discusses diversity in leadership, healthcare challenges, and why she chose pathology in this Q&A.
Why is diversity in leadership critical to the success of a laboratory?
We can look at success using various criteria and if we take one measure that is often used—financial reward—then there is reliable evidence that a diverse workforce outperforms less diverse ones financially. Taking a more altruistic view: given that front line laboratory staff is often already diverse when we look at gender, gender identity, ethnicity, age, and countries of origin as some markers, diversity in leadership is validating to the team and promotes a greater spirit of participation. Diversity in leadership fosters a culture that is inclusive and accepting, which in turn promotes cohesion and productivity. It attracts much needed personnel to consider joining or growing in the laboratory since more of the team can envision a path to leadership. The patients we serve are often diverse and the ability to see ourselves in others is often the trigger, whether rightfully so or not, for improved patient care.
What are some of the systemic healthcare challenges that affect Black people, and what role can the laboratory play in addressing them?
Systemic healthcare challenges are similar to systemic challenges outside of healthcare. In so many areas there has been normalization of substandard care on the basis of contrived differences in Black people and a core inability to treat Black people as human. Black suffering is perceived as non-existent or academic and is frequently highlighted and exploited for the advancement of healthcare and medical education, if considered at all—look no further than the Tuskegee experiments, although several additional examples exist. These challenges include lack of access to adequate healthcare, increased chronic health conditions and more adverse outcomes in Black patients relative to White patients in almost every context. Black people have the highest mortality rates for all cancers, have the highest infant mortality rates and the worst outcomes in pregnancy. Even when healthcare is readily available, the timeliness of diagnosis and adequacy of treatment are issues Black patients encounter disproportionately to White patients.
Laboratories have a critical role to play that we must embrace. We have only recently started to reckon with the norms we have facilitated in the laboratory that may actually not be normal. The traditional methods of establishing reference ranges for most laboratory tests have excluded non-White people, promoting abnormalities where none exist resulting in unnecessary intervention and procedures—neutrophil counts in the context of the absence of Duffy antigen and benign neutropenia, and where reference ranges exist that are adjusted for Black people, potentially harm their ability to receive adequate care early—the use of the MDRD equation for EGFR in isolation as a determinant of kidney function. Laboratories must develop more appropriate standards for defining “normal” or evolve to potentially patient specific reference ranges. We have to work with non-laboratory partners and physicians to develop patient centric care pathways that incorporate laboratory testing and mitigate the arbitrariness of patient care—high sensitivity troponin T comes to mind. We must employ quality control mechanisms that ensure patient follow is adequate and reduce the lack of follow up in underserved populations, some of which may be due to patient social circumstances, but also sometimes due to physician indifference to the traditionally underserved—follow up of Pap smears and small biopsy results come to mind in clinic settings. In anatomic pathology we should employ routine ancillary testing as best as reasonably possible to ensure that patients have access to information that facilitates treatment, like PDL1 testing, or alters patterns of surveillance of family members like MMR/MSI testing. Pathologists must use a reasonable scientific basis to determine cause and manner of death, and ensure that we are not coopted by the will of those with a stake in the outcome. We have to become creative and recognize that we are clinicians; these are our patients too, we just see them in a different “office.”
How did you learn about Pathology and Laboratory Medicine, and what do you enjoy the most about working in this field?
I often say I was born to be a pathologist. I first became interested in pathology when I had an obsession with [the television show] Law & Order, an obsession that has run through indifference to an acknowledgment of the ideas and stereotypes perpetuated by shows like Law & Order—but I digress. I was fascinated by forensic pathology and the concept that ultimately, pathology and the autopsy had all the answers—again, a position I’ve evolved from. Nevertheless, the why, the how, and the concept of the last word in pathology and laboratory medicine was captivating and I’ve never looked back. I’ve gone from training in forensic pathology to practicing academic GI and liver pathology and autopsy pathology, to now community general pathology to a laboratory leadership role and it has always been tremendously rewarding. Truthfully, many areas have picked me, rather than the other way around. I have been fortunate in mentorship and opportunity and have taken advantage of both and at this moment, I have no boring days. My current responsibilities came from a desire to be in leadership, to be part of the decision-making process in laboratories, hospitals and medicine, to incorporate and drive processes that optimize patient care, to be able to share my passion and love for pathology and lab medicine and “use my powers for good and not for evil.”
I would like to think that I have been able to move the needle just a bit. That is where I am the first and only, I will never be the last, that I have created opportunities for many, including those who look and are like me and that I have improved the lives of others. It is not just a hope as a professional legacy, but also a personal one. Each day my focus sharpens more on ways to improve healthcare for those who need it most, beyond what I imagined when I sought out life as a forensic pathologist; let’s hope my legacy is that every day I do more than the day before.
Read more Q&As here.
This interview has been edited for clarity and length.
Director of Pathology