The Modern Pathologist with Dr. Mohammad Kamal

Dr. Mohammad Kamal 0:17
Well, thank you, George, for having me. excited to have you on telephone about your personal lives more about your work, why you do what you do.

Dr. Muhammad Kamal is a medical doctor. He is the CEO of Omni pathology laboratory. He’s a practicing pathologist and educator specializing in gastrointestinal, and liver pathology. Welcome Dr. Dr. Kamal.

Speaker 2 0:26
So I am a medical doctor specializing in pathology. I was born in Washington, DC, I grew up in Egypt, I went to medical school in Cairo University. And then it came to the United States to continue my medical career. I did a residency in pathology at Harbor UCLA, followed by a fellowship in gastrointestinal and liver pathology at UCLA. When I finished my training, I pursued practicing pathology in a in the community, rather than going to academic route. And I started my laboratory on the pathology in 2009. And I have a passion for the practice in the specialty of pathology. And we’ll talk more about what drives me in this field.

Dr. Mohammad Kamal 1:22
Yeah, I appreciate that very much. So you’re born in DC, and then tell us a little bit about how that transition happened.

Speaker 2 1:31
So my dad worked in the Egyptian embassy in Washington, DC, my parents lived in, in the United States from, I’m gonna give up my age, but it’s okay. So in the mid 60s, they lived here, and then his service ended in, in DC, and I had to go back. So when I went back to Egypt, I was two years old. So I have no memories of my app, and a lot of pictures from being in DC and pictures in the snow, but no memories of of living, because I was two years old when I went back. But that kind of like being born in the United States, and being a citizen by birth facilitated my coming back to pursue my medical career. Got it.

Dr. Mohammad Kamal 2:19
I appreciate why pathology.

Speaker 2 2:23
So very interesting route to pathology, because when I went to medical school from day one, everything I studied about the heart was attractive. I liked the anatomy of the heart, the physiology of the heart and pharmacology of the heart. Everything about the heart was fascinating to me, and I finished in Cairo. And I said, I’m going to be a cardiologist. When it came to the United States, I, I had to study to take my boards and be eligible to apply for residencies. And during that time, I was working and I worked in a laboratory. And from that work in the level of the lab technician, and then I did some research in medical devices and diagnostics. And by the time I finished this work, and was applying for residency pathology, I was a much more attractive candidate for pathology than for cardiology, the second aspect of it is cardiologist. And during the residency and training, they take calls and they sleep outside of the house. My wife and I were engaged in Egypt and got married and came. So now we have a small family, I felt the lifestyle of a pathology, residency and pathology work will allow me to sleep at home every night, and a and I felt that pathology is a good fit. So I applied a little bit of flexibility in accepting pathology I got in and then I fell in love with it.

Dr. Mohammad Kamal 3:46
It’s funny how that works. Because you know, doing the work and getting really serious about it obviously getting really good at it leads to passion.

Speaker 2 3:56
Yeah, because also, some people, they have interest in things to the level of obsession, which I completely respect. I didn’t really want to be that rigid about it. And also, I have to confess I when I got into pathology, I wasn’t really sure that I loved it in the first couple of years. And there was a point where I said, well, I need to win a sub specialized, what am I going to do? And they could fight and I was really anxious about that. But then as soon as I found gi pathology, and I did an elective at UCLA, and everything clicked and I said this is it. This is my specialty sigh I love gi pathology.

Dr. Mohammad Kamal 4:37
Excellent. So fast forward or tell us through kind of a little bit about your career path. I’m not sure the traditional career path for a pathologist to most open up their own company, their own their own laboratory. No, I

Speaker 2 4:55
this is also another interesting thing that I did sigh finish Standing worked somewhere. And I had a 14 month work experience that I would like to forget. But it, it made me who I am today. And, and after doing that, I figured, okay, you know, this is not the right type of practice that I need to be in. So luckily, my my background and labs before pathology and other things allowed me to be attractive for, for a large organization, they were building a lab in LA, and wanted to hire me as a medical director. So I started as the medical director, I hired all the pathologist and a, and they actually have a picture where I’m standing there, and they have drywall that they had didn’t have even built with it hadn’t built the lab yet. And, and immediately, I found that I mean, I liked doing this, a lot of senior pathologists that I knew from the past, during my residency kind of helped me in, you know, what I need to do to become a medical director. So it was a medical director, two years after I finished my fellowship, which is kind of like a very fast track for it, but without their help with their advice, with their guidance, they mentored me. And it was a tremendous help for me. I’m the kind of person that I consider myself a lifelong learner. So I always want to learn, I always want to improve, and I want to go where the information is, I have no ego when it comes to knowledge. So I did that. So I did very well, in that position. That lab was extremely successful. I was recognized by the organization, I became the go to person for the GI pathology specialty. And then, after five years of doing this, I just had a moment where I felt, you know, if you’re doing this very well, you might as well do it for yourself. And not that I wasn’t allowed to do things in that organization. I think this organization was my launching pad. But because I had specific philosophy about practicing pathologist, I have a term I send the modern pathologist, which is a pathologist who is proactive was going out and and being communicative with with with clinicians, pathologist in hospitals, if you remember, like not everybody, you know, the typically they’re in the basement next to the morgue. They have no windows, they don’t want to talk to anybody. The images that you see in TV series are like all these fancy looking morgues, right. I mean, we don’t have that these are only on TV. But I said pathologists needs to take a more active role in is to be he or she needs to be more communicated with whether the clinicians and proactive about things. So I said, Okay, let’s do it. So I did that in 2009. And started on the pathology, we’re in the same location where we started. And I said, I’m going to build a specimen by specimen. But I want to apply the principles that I have acquired over the years, and I wanted this lab to be a physician owned lab that is mainly focused on quality and being a patient advocate.

Dr. Mohammad Kamal 8:20
Well, that sounds like it makes sense to me. So proactive working with the clinicians. What does that what does that mean?

Speaker 2 8:30
So we have a saying, Somebody told me this joke, and he was a marketing person, but he knew a lot about pathology. And he said, the difference between an introvert pathologist and an extrovert pathologist is that when you talk to an introvert pathologist, he’s looking at his shoes. If you’re talking to an extrovert pathology, he’s looking at your shoes. So there is this idea that if I was doing a talk to people, or they got into pathology, because they don’t want to deal with patients, but they also don’t want to deal with people, period. Right? For me, I feel that we are an integral part of the healthcare operation. We make the diagnosis. And based on the diagnosis, treatments are determined. We get samples that may not have sufficient information, it’s our job to call and ask the questions. We we have knowledge about other diagnostic possibilities that we must be able to communicate effectively. I can see a GI biopsy slide and it would have five or six different potential diagnosis. We call that differential diagnosis. It is it is my job to communicate what I think this diagnosis is but also to communicate the other diagnosis that need to be ruled out. without being proactive, and without picking up the phone and calling and saying, by the way, the sample that you gave me, was it from an N, mass or polyp? Or was it a flat lesion with you know, all these details, if they’re not given to you, that doesn’t mean that we can’t call and get that. So that proactive approach that being being proactive also means that eventually you will develop into a true consultants, we should really consider ourselves that the doctors doctors, we are the consultant that the doctor will call and say, by the way, that diagnosis he gave me, you know, it doesn’t really fit with the clinical picture. When I hear that I shouldn’t take offense, I should say, Okay, what’s in the clinical picture that I didn’t really hear? Tell me more. And then once I hear that, then I say, oh, you know, it could be this, it could be that or even better. I can say, You know what, I think I’m going to send that case for a second opinion, should never be an ego about this. And I always I sometimes I teach. And I, I really focus on young pathologist and pathologists and training and things like that, I actually tell people that sending a case for a second opinion is a win win. Why? One, if you have a diagnosis, and you sent me for a second opinion, and they confirm it, then you establish you know, your knowledge and establish the confidence that your clinician senses a biopsy will happen you. But if it’s wrong, you show that you are one person who has confidence that you don’t have the ego, you’re worried about that the ultimate goal is the best patient care, the best diagnosis. And then, and then you also demonstrate good judgment. When you’re talking to the doctor who sends it the vibes and say, by the way, I said that I think this patient needs a second opinion. I sent it and that’s what they thought about the diagnosis. And you know, I didn’t think about it, but it’s good. So now and then you learn from that second opinion. And you apply the same diagnostic criteria. That was that were used in that diagnosis from the consultant, they apply the new future phases.

Dr. Mohammad Kamal 12:02
That makes a lot of sense. Why don’t other people do that? My guess is no, I can.

Speaker 2 12:08
I can’t say that other people don’t do that. I talk about it, because I want people to understand more about what pathologists do. Right. But I would never claim that other people don’t do that. But I’m more vocal about it. Because I think that, you know, I think pathology is a great specialty. And I think that you if you talk to little children, and you say what do you want to do when you grow up? A lot of them would say I want to be a pediatrician, I want to be a doctor, I want to be a surgeon. I think if you talk to a child and tells you I want to be a pathologist, it would be really weird. It would be strange you have you have to figure out what is what is wrong with that child? Or how do they know about it? And maybe, maybe maybe the dad or the mom are pathologist, but I remember my my second grade child, second grade teacher was telling me I’m so proud of Andy because he’s the only child that can spell pathology.

Dr. Mohammad Kamal 13:06
So funny. Love it. So, so many different questions I have with technology, I imagine that there’s an inflection point between making your job better and just not.

Speaker 2 13:24
You know what I can tell you this. I am never intimidated by technology. I truly believe that any technological advancement that results in better diagnostic capabilities. I’m all for it. Right. So I think that this is an essential part of the progress of human race, we have to always be willing to, to take the technology of technological advancement, understand it, and employ it to to help us so when you hear about artificial intelligence, and you’d think that you know, it’s going to be replacing certain activities and physicians and things like that or replacing specialties in particular right, because they have these, they have this list of things that they say these will be replaced by, by by technology, right? When when you think of that, I would tell you that artificial intelligence is going to make the performances diagnostic accuracy higher. Also, when you incorporate an artificial intelligence with diagnostic data, then you may be able to have a better picture for the treating physicians to to use and to maybe have targeted treatment for Patients that are giving medication everybody with that symptom that syndrome or that disease, you may be able to say, Okay, no, no, what we’re going to do is that this patient based on the data that we’ve fed that AI program is going to result in a more specific treatment for that kind of patient, because the data shows that these types of patients respond better than Yeah, warfarin. So I, I am a kind of person that what comes to that, and I think people will fight technology end up being left behind.

Dr. Mohammad Kamal 15:31
Probably true, probably true. Are you Does, does does Omni do you work with insurance companies? How does that work? Oh, that’s an interesting question. George, can you can you rephrase that a little bit. I know that there are some medical fields practitioners that are moving away from from insurance. Is that viable? Is that something you’ve considered?

Speaker 2 16:03
I think that the the honest answer is what is happening in our industry, when it comes to reimbursement reimbursements is completely unacceptable. It is it’s almost getting to a point of destabilizing the industry. Because I I’m going to be very honest with you about this, because I think it’s it’s it’s something that the audience needs need to hear. If you will learn anything from COVID. Right, what happened with COVID hit? In America, we thought we have the most advanced healthcare system, right? And a little virus brought the system to its knees. Right? Why? Because we started to see that we have shortages and things that we’d never thought we would have shortages. We couldn’t find swabs, let alone testing, right. And then what happened, we were not a large organization. But we got letters from the California Department of Public Health and from FDA telling us there are shortage of testing. And we need to we need labs like yours, because labs have different classifications. And if you’re classified as a high complexity laboratory, you could develop your own tests, they call them lab developed tests LDTs, they said, we encourage you to develop your own COVID test because there is shortage of COVID PCR testing. So please develop your own tests. And here’s a guideline of what to do to apply for the FDA. emergency use authorization EUA. So that was something sent to all organizations, not just the big ones, right. So what I’m saying with this point is that all medical technology, organizations, big and small, need to be supported, they need to continue to survive. And there has to be effort to maintaining these organizations, what we see now there is a shift, where the, the big organizations are benefiting from rules and reimbursement cuts and things like that. And there are exclusions that are happening for a lot of smaller organizations. And at the end of the day, it’s not good for the healthcare system, that you only have big groups, big hospitals, the big hospitals, by the small ones, the big labs by the small labs and groups, you know, are being swallowed by larger groups. And by hospital brain, I don’t think this is good for our health care system. And I don’t really think that this is the only economic way to reduce spending, there are ways to reducing spending, and there are so many efficiencies that could be done, but to just blindly cut reimbursement by half and stuff like that. This is not it’s not thoughtful, it’s not intuitive. It’s not productive. And that’s my personal opinion. But again, I’m not really saying that we’re not getting paid enough. What I’m saying is that there needs to be other things implemented in our healthcare system to allow the specialty so solo practitioners to survive.

Dr. Mohammad Kamal 19:18
It makes sense and if the mission is, is great treatment, you know, for the patient. My sense is that you would want to have, for lack of a better term, smaller organizations that are able to be connected with community and have relationships with the practitioners like you’re working to do not that big is bad, necessarily, but big has consequences, just like small has consequences.

Speaker 2 19:48
And also, I don’t want to dwell too much on this, but let me give you an example. You’re going to the doctor, which of these two scenarios you would feel better about a scenario where when the doctor takes a bite Obviously from whatever God perhaps it from you and says to you, I’m going to send this to this specialized lab, B do gi only. And they’re really good at what they do. Or George, your insurance dictates that I have to send that to this particular lab. And and then he would ask, Does this particular have a GI pathologist? We don’t know. Do they are known to be better? If they have? Did they have better? No, no, we don’t they just want us to send all the cases from your insurance plans to this lab? Which would you feel better? You feel better when that your doctor has independence in the decision making? Right? Yeah, I tell people, the choice of where to send the sample is a clinical decision. It cannot be dictated by by by an insurance company. I’m I’m sure I’m I’m I hope that I don’t create a lot of enemies from this risk. But I don’t care. I mean, I’m saying my opinion, this is this is exactly, we need doctors to be independent, and we need them to make decisions on where to send their samples without really restrictions.

Dr. Mohammad Kamal 21:10
And that would be as a patient, what I would want 100%, I would want the doctor to be able to utilize their exercise their discretion and the best way to treat me and my needs. That’s that’s what I’m interested in instead of, you know, moving in, move out, George, we have three minutes together. And that’s it. And I’m going to get your biopsy, and I’m going to send it over to the you know, super lab over here. And we’ll kind of see what happens. I’m disinterested in that I want personalized care. And I want the best people to best people possible to be working on my case. Right. So we can all agree on that. Let’s just wave our magic wand and start doing that doctor. Was that easy? Yes. Yes. Well, Dr. Kumar, thank you so much for coming on. Where can people learn more about you? How can people engage with me, pathology laboratories.

Speaker 2 22:05
So our website is only pathology.com. On that site, we have different types of testing that we do. We are particularly now pursuing tests in oropharyngeal cancer to test for HPV. So we have a page for that particular test for patients and pays for healthcare providers. Also on YouTube for you just go look up on the pathology. There are videos for me giving lectures on oral pharyngeal HPV and other tests that we do. And we have a lot of education material on our website, there’s a page for education, we have case studies and things like that. And of course, someone Facebook, and Instagram.

Dr. Mohammad Kamal 22:49
Excellent. Well, if you’re enjoying as much as I did show Dr. Kamal, your appreciation and share today’s show with a friend who also appreciates good ideas go to Omni pathology.com. Check out all the resources and educational materials that Dr. has been talking about. You can find them on YouTube under Omni pathology, and I’ll list that as well as Facebook, and all the other places on social media and the internet will list all those in the notes. Thanks again. Dr. Come off.

Speaker 2 23:17
George, thank you so much for having me. I appreciate it. Till next time,

Dr. Mohammad Kamal 23:20
remember, do your part by doing your best