3 Questions with Matthew Hernandez, MD, PhD

Nick News with Linda Ellerbee in the early 90s was where Matthew Hernandez, MD, PhD, learned about a virus called HIV that had changed the lives of basketball star Magic Johnson as well as kids his own age. The idea that a pathogen could profoundly impact someone’s life resonated and ignited his interest in understanding the eternal battle humans face with microbes. 

During medical and graduate school his exposure to virology further reinforced this passion, but it wasn’t until a pathogen surveillance project opened his eyes to the clinical microbiology laboratory. There, he saw how every day was shaped by a mixture of detective work and basic microbiology that utilized advanced tools and data to identify the pathogens driving diverse disease processes. From that moment he was captivated by clinical pathology and the experience scratched a cerebral itch as it exposed him to a world perfectly positioned amidst patient care, research, education, and teamwork.  

Here, Dr. Hernandez shares insight to his journey through microbiology, challenges facing the laboratory, and more.  

What do you see as the biggest challenges facing pathology today?  

As pathologists, we are at the forefront of diagnostic innovation and are faced with the challenges of 1) determining how to implement novel technologies in clinically meaningful ways and 2) ensuring an understanding of the utility of such tools among different stakeholders. With evolving technologies rapidly becoming available, we need to rigorously evaluate these assays to form a clear understanding of the results and what they actually reflect in disease pathogenesis. This requires critical assessment of available literature and incorporation of perspectives from industry partners. We are then tasked with optimizing how we use these tests so that we are efficient as a lab and generate results that shape clinicians’ decision-making to provide high-value care for our patients. After all, not every patient requires an expensive metagenomic assay, and not every provider requires such complex results to manage them in the best way possible.  

As a result, we need to meet with patient-facing providers and hospital leaders to ensure they understand the utility and limitations of these assays prior to thoughtful implementation for specific patients. Finally, using our expertise as diagnosticians, we also face the challenge of being able to effectively communicate this work with stakeholders outside the medical system. While no easy feat, this ensures both patients and policymakers understand our role as pathologists as well as the rigor involved in thoughtfully implementing new assays and utilizing the results generated.  

Pathology often involves working with cutting-edge technologies and diagnostic tools. What excites you about incorporating these advancements into your daily practice?  

One of the things I love about clinical pathology is how we are constantly advancing in techniques and richness of diagnostic data. Personally, I am always excited to learn about the potential utility of novel molecular assays in the microbiology laboratory. Given the intrinsic complexity of the micro lab, cutting-edge tools have the ability to accelerate identification of pathogens and to increase the level of granularity behind outbreak investigations. I also enjoy the opportunity to work alongside stakeholders (e.g., infectious disease and infection prevention colleagues) to select the most valuable of these tools. Ultimately, the most exciting part is seeing innovative assays in action as they not only meet the needs of clinicians and patients but provide rich datasets that opens the door to translational research into better understanding the mechanisms driving infectious disease pathogeneses. 

What advice would you give to someone considering a career in the laboratory? 

Come to the lab! The clinical laboratory can often be thought of as a mysterious realm of pipettes and organisms and whirring machines where very few dare to go. Indeed, during medical training, clinical pathology is often a footnote in core clinical education, and few get to see the lab as something more than a black box generating results. In reality, we are people who love to work together to catch the bacterial culprit causing a patient’s illness, to identify the molecular drivers of someone’s cancer, or to optimize blood products for delivering a newborn. Once you look behind the curtain, I encourage you to follow technologists, pathology trainees, and directors to gain a better understanding of the diversity of cases we constantly see as well as the work and thoughtfulness that goes into supporting diagnostics and generating meaningful results.