1. Name and affiliation:
Zehra Ordulu, MD
University of Florida, Department of Pathology, Immunology and Laboratory Medicine
2. What is your professional title?
Clinical Assistant Professor.
3. How did you decide to enter the field/what (or who) brought you into the field?
As the daughter of two physician parents, I was introduced at a very young age to the wondrous world of medicine through their combined clinical practice in Ankara, Turkey. My mother, a clinical pathologist, ran the laboratory tests, and my father, an internist, managed his patients accordingly. I saw how the synergy of two important disciplines in medicine translated into relieving human pain and suffering. This led me to the pursuit of a medical education.
4. What do you do?How would you describe your role?
My main role is being the gynecologic pathology subspecialty co-director, which was an unnerving title for me as I was freshly out of training this past summer. Luckily, I have had an amazing support system both among my current colleagues and also through my past (or better to say ongoing) mentors. Slightly more than half of my clinical effort goes to signing out gynecologic pathology cases. The rest is mainly spent on molecular pathology. For the molecular part, I am in charge of interpreting and signing out all the in-house NGS cases almost every week. As the only anatomic pathologist in the department signing out NGS results, I try to be the bridge between the two worlds and not only just render the reports but also communicate and follow-up about the complex, unusual or interesting findings to the pathologists and/or clinicians. In addition, I am preparing a structured curriculum for the molecular pathology rotation of our residents that we are hoping to go live starting next academic year.
5. What degree(s) and/or training did you receive to achieve your position?
After getting my medical degree at the Hacettepe University Faculty of Medicine, Turkey, I worked as a postdoctoral research fellow at Dr. Cynthia Morton’s laboratory at the Brigham and Women’s Hospital. Opportunities for learning, teaching, and accomplishments were immense during my research fellowship. Being a leader on the first team that performed whole genome sequencing (WGS) on a prenatal specimen with a chromosome rearrangement gave me the chance to work with clinicians and researchers from various disciplines. This experience crystallized my realization that effective cooperation as a team brings the most gratifying feeling of reaching for a common goal: delivery of the best medical care to a patient. While devising a new suggested next-generation cytogenetic nomenclature to describe WGS results, I grew to appreciate the power of communicating test results using a systematic classification. My research fellowship was followed by anatomic and clinical pathology residency training as well as selective surgical pathology fellowship focusing on gynecologic and obstetric pathology) at the Massachusetts General Hospital, Boston; where I had the great opportunity to work alongside world-renown pathologists with high-volume, subspecialty focused sign-outs. Last year I completed my molecular pathology fellowship at the combined Harvard Medical School program, during which I was exposed to the workflow of multiple laboratories, which prepared me to be adaptable to different scenarios and laboratory conditions in my upcoming faculty position. After 10 wonderful years of postdoctoral training, I am finally practicing as a board certified anatomic, clinical, and molecular pathologist.
6. What is the greatest challenge you face in your work?
I think one of the biggest challenges in our field is the lag between new discoveries in the research world and implementing those advances to routine clinical practice and of course, the repercussions for the patient management and health care dollars along the way. I find myself asking: “Are you willing to skip this molecular test that can provide useful prognostic data but may not be paid by the insurance? If a patient gets only one shot at NGS due to their insurance policy, which targeted panel should I choose for this case that can cover all the genes of interest? Does it provide structural variant data including CNVs? What about TMB and MSI?” Lastly, even when a new test/new angle of an existing test is acceptable for the clinical practice and I have the technical equipment to run it, how do I find enough samples to validate? How can I be sure about the cost effectiveness of doing it in house versus sending it out? And so on… I almost wish I could travel a decade or so into the future, to a point in time where most of these dilemmas will hopefully be settled and NGS will run as seamlessly as any other more traditional ancillary testing (e.g., immunohistochemistry) (although I guess we will most likely be dealing with a new set of challenges by then).
7. What is the best part of your work as you see it? (most interesting, most fun…)
One of my biggest passions as a pathologist is to strive for the best possible patient care in this era of precision medicine. Towards this goal, whenever I have a challenging case, I find it exhilarating to narrow down my differential diagnosis and support what I favored morphologically with additional layers of data, let it be at the protein level with immunohistochemistry or genomic level with sequencing and ultimately inform the next steps in the clinical care. In my day to day practice, I love to stay connected to my “inner MD” and consider myself as an important part of the clinical team taking care of this patient even though I don’t personally meet the patient. Before I sign out a case, I correlate what I have in my report with the clinical impression and always try to remember my pathology report will show up in the patient’s online medical record tracking system. Therefore, I think communication with the clinical team as an essential part of my practice, particularly before releasing an unexpected or untoward diagnosis and also for the clinicians to structure the next steps in the patient management as soon as possible.
8. Optional follow up question- what do you do for fun?
I have a 4-year old son, Yusuf, and as a junior attending, the majority of my “fun times” are filled with him. One of our favorite activities together is riding our bikes side by side. Yusuf and I started to have long bike rides together when COVID first hit and we were on lock down (at the time he was riding in my toddler seat). Since then I have been commuting to work with my bike; first in Boston and now in Gainesville. My current ride is about 10 miles each way, which takes me about 35-40 minutes. I should confess I am using an electric bike, however, it is pedal assist; so it is the same effort but more miles per hour and not completely cheating on the exercise!