October 23, 2025 • 13 mins
5 Questions is a new series of Blood, Sweat and Smears, hosted by our Senior Director, Bjorn Stromsness, who asks 5 questions to physicians in and around the disease areas we work in.
In this episode, we are joined by Clinical Associate Professor of Hematology at Stanford Medicine, Dr. James Malone, Colonel and Command Surgeon of the U.S. Army Reserves.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:05):
Hello and welcome to Blood, Sweat, and Smears, your
Maecheon Diagnostics podcastwith tag team hosts, including
our medical director, Dr.
Brad Lewis, Senior DirectorBjorn Stromsis, that's me, and
other guest hosts.
We hope you find these podcastsinteresting and informative.
Thank you for listening, andaway we go.
(00:28):
Hi, my name is Bjorn, continuingour series Five Questions,
posing five questions tophysicians in and around the
disease areas we work in.
Today we are joined by Dr.
James Malone, Clinical AssociateProfessor of Hematology at
Stanford Medicine.
That's right, straight onclassical hematology.
We are also joined by Coloneland Command Surgeon James Malone
(00:50):
of the U.S.
Army Reserves.
Huah, and thanks for joining ustoday, Dr.
Malone.
SPEAKER_00 (00:57):
Mega Hua to you, Bjorn.
Thanks for having me honored andpleasured to spend some time
with you and uh and answer a fewquestions, hopefully, that are
of interest to our mutualaudience.
SPEAKER_01 (01:08):
Okay, on to our first question.
I know you've done a shift inhospital administration in your
career, and I'm wondering howbeing a physician informed how
you approached your work as anadministrator.
SPEAKER_00 (01:21):
No, thanks for asking that question.
It's increasingly a commoncareer path or way to blend both
sides.
I learned a lot about leadingsmall teams and leading
hospitals in the Army and foundit a natural transition to blend
what I did in hematology withwhat happens in the hospital and
(01:42):
healthcare system.
You know, one of the things thatI found was key was to continue
to do both things.
It's challenging to do that.
You know, when one becomes achief medical officer of an
acute care hospital, thebandwidth of time to then being
an active clinician stilldiminishes greatly.
But I found it was reallyimportant to be present
(02:06):
clinically to your colleagues inorder to be able to influence
what they do and don't dorelative to hop operations,
quality and safety and service.
So I never stopped being aclinician, mostly because of
that, also because of just purelove for hematology.
(02:27):
I can't imagine giving it up inany fashion.
SPEAKER_01 (02:31):
That's what we like to hear.
So, second question is how didyour time as an administrator
inform your work as a practicinghematologist?
SPEAKER_00 (02:40):
That's also a great question.
You know, when we trainresidents and fellows, we always
focus on things that we callsystems-based practice.
And that really means how welldoes one understand and use all
of the tools of healthcare?
You don't really understand andlearn that until you start
(03:01):
dipping your toes into theoperation side of how healthcare
runs, and particularly ahospital.
So I spent countless hours inevery department of a hospital
understanding how they worktogether and how they don't work
together.
And one of the things I reallylearned, and this was cemented
home during COVID, is thatpeople didn't understand how the
(03:22):
laboratory works and howimportant laboratory medicine
is, how useful it can be, howmuch it can be misunderstood and
misused and misunderstood.
So I really became a much betterclinician and particularly able
to train the next generation ofhematologists by really
(03:42):
understanding how a hospitalworks as an organism.
And that's really how I how Isee a hospital.
It's no different than the humanbeing.
It's got all these differentdepartments or organs that work
together, hopefully, sometimesdon't.
And the better we understand itsstrengths and weaknesses, the
more we can help others do thesame.
So those two have really gonehand in hand.
SPEAKER_01 (04:06):
And we didn't pay you to hype up the lab there.
SPEAKER_00 (04:10):
So just so everyone knows that.
No, negative.
I've I've always told everybodyI'm a I'm a laboratory
professional at heart.
You know, a good portion of myearly career at Stanford was as
the associate director of theBlood Bank and Transfusion
Service as well as Special CoagLab.
So I've always been a kind ofhalf clinician, half clinical
(04:32):
laboratory uh specialist, andalways always tell everybody I
work with that's often where myheart lives.
Fantastic.
SPEAKER_01 (04:40):
Yeah.
All right.
Third question.
So you split your time betweenStanford and the U.S.
Army.
And what do you experience asthe strengths of those two, and
I'm assuming here, verydifferent worlds?
SPEAKER_00 (04:51):
Yeah, it's an interesting shift.
I was, you know, just recentlyover in an area that the Army
has a big role in, which iscalled Central Command or
CENTCOM, which is thetraditionally what people know
is the Middle East, basicallybeing a chief medical officer
there or Army healthcare assets.
And people might think thatthere's not really any
(05:12):
parallels, but really theday-to-day key tasks and skill
sets are exactly the same.
You have to understand howcomplex systems work.
You have to be able to leadsmall teams, you have to be able
to know what your mission is andwhat your desired end state and
(05:32):
goals are.
Otherwise, you can really getlost out there and put in a lot
of effort, a lot of work, andnot accomplish a lot.
So I think really the the keythings that tie the two together
are the importance of teamworkand particularly in person.
This world of remoteness thatyou and I are doing right now is
great for a lot of things, butthere's nothing that substitutes
(05:56):
for just being in the trencheswith each other.
And that's the same whether I'mover there in the desert or
whether I'm on the inpatientconsult service at Stanford.
It's being present to developrelationships, to lead teams is
the thing that you need todevelop acutely to be able to
succeed in either of thoserealms.
SPEAKER_01 (06:17):
Great.
We recently were able to assistin a case you had while
deployed.
Can you share any of thatexperience?
SPEAKER_00 (06:25):
Yeah, I sure can.
You know, the I can say my 30years in the Army, I've probably
been used as a hematologist lessthan a handful of times.
People always ask me when I showup at a at a new base or a new
location, well, hey, sir, what'syour specialty?
And I joke around, I say combathematology is what I do.
And once in a while I do getcalled for that.
So in the midst of the conflictand the war between Iran and
(06:49):
Israel recently, I was notifiedthat one of our U.S.
service members was gravely illin a civilian hospital in the
Middle East.
And it just so happened thateverything I was told over the
phone made it sound like atypical HUS or TMA that was
going on.
So right when uh the conflictended, six hours after that, I
(07:12):
was on a plane to the countrywhere this soldier was to go to
the bedside and help diagnosewhat was what was happening.
And it was really clear to methat that this poor individual
had a severe life-threateningthrombotic microangiopathy, and
it wasn't clear why this was.
I spent a few days ruling outthe things that I could rule out
(07:34):
there, but then the thought cameto mind that geez, I think I I
need some special teams players.
And of course, you know, Mechiandiagnostics came to mind of
helping me understand that thisthis gentleman have an inherited
tendency to develop thisproblem.
And uh I was able to draw bloodspecimens from him and Bjorn,
(07:56):
with your and your team's help,able to rapidly get a TMA
genetic panel done, which wasvery instructive in telling us
that yes, indeed, thisindividual had a known risk
factor for developing thisproblem and we had the right
diagnosis.
Unfortunately, despite all ofour best efforts, he he died of
his underlying illness.
(08:17):
But it was critical to be ableto tell his family, and
particularly his one survivingbrother, why we thought his
26-year-old brother slash sondied of illness uh while on
active duty in the service ofhis country, and to be also
share with them that, yeah,there is a genetic predilection
(08:37):
that we should pay attention tofor his brother and also other
members of the extended family.
So it was it was critical to beable to have that worldwide
reach of the expertise andtalent that Mechan presents.
And I'm forever thankful to beable to just reach out to you
and your team by any meansnecessary and get that
assistance.
SPEAKER_01 (08:58):
Well, we were very honored to play a small role.
All right, our fifth questionclassical hematology often
doesn't get the respect itdeserves.
So, what would your elevatorpitch be for your subspecialty?
SPEAKER_00 (09:14):
I would ask the person in the elevator, tell me
the most common laboratory testordered in the United States
annually.
And I bet you, even if theydidn't know, they could guess.
It's a CBC, right?
So, therefore, there's so manyopportunities for classical
(09:34):
hematology to get involved inthe care of just about any
patient because routinely you'regonna find some abnormality
there that needs someexplanation and understanding,
and that's often the window intoso many other disorders and
diseases that the patient has.
So it's it's again, it'ssomething that every
(09:55):
practitioner looks at regularlyin their patients, but
understands often the least.
The other pitch I would givethem is that we are about the
busiest consult service in thehospital.
We routinely carry over 20patients on our inpatient
consult service, ranging fromlabor and delivery to the
(10:17):
emergency department, cardiacICU, pre-op surgical area,
medical teams, solid organtransplant, and bone marrow
transplant.
There's no corner of patientcare where classical hematology
doesn't touch.
And we're a huge enabler of allthese other important
life-saving services.
(10:37):
We're constantly trying to tellStanford Medicine how important
we are.
Of course, we pat ourselves onthe back every day and try to
share with them our impact.
But really, classical hematologyand systems-based hematology is
critical to the ability to runtertiary and quaternary care
centers.
It's not possible to do itwithout expertise on site.
(10:58):
And that also includes expertisein laboratory diagnostic
services.
SPEAKER_01 (11:03):
Fantastic.
So if you're keeping score athome, that is five questions,
which brings us to our bonusquestion.
And that is what is somethingyou'd recommend?
And it can be absolutelyanything.
SPEAKER_00 (11:20):
Do things occasionally that are way
outside your comfort zone.
One of the sayings I heard along time ago that I try to
subscribe to is you know, lifebegins at the end of your
comfort zone.
I constantly try to put myselfin little situations that are
not particularly of high risk tomyself or others, but that make
me uncomfortable.
Because it's only when I do thatthat I start to learn about
(11:44):
myself, about others, and aboutthe world.
So I would say get out there,get a little bit uncomfortable,
and you'll actually be betteroff because of it.
SPEAKER_01 (11:54):
Yeah, it's great advice.
Uh, and while this conversationwas well within my comfort zone,
I'll look for an opportunityhere shortly to get outside of
it.
Thank you very much for yourtime today, Dr.
Malone.
Really appreciated your commentsand your words.
SPEAKER_00 (12:13):
I'll just say in closing, you know, one of the
things that I think we have incommon in the Army and your team
has in common with us is ourapproach to our work.
You know, we always say missionfirst, people always.
But that's also the sameapproach that you and your team
take to your work.
SPEAKER_01 (12:31):
Very much appreciate it.
Thank you very much.
SPEAKER_00 (12:33):
Absolutely.
SPEAKER_01 (12:35):
That's it for us here at Blood, Sweat and Smears,
a podcast produced by MachionDiagnostics, your reference lab
and CRO specializing inthrombosis, hemostasis, and rare
disease.
Thank you for listening.
And if you have a question orcomment or there's a topic you'd
like Dr.
Lewis to speak to, please sendus an email to BloodSweat and
Smears at MachionDiagnostics.com.
(12:57):
That's M-A-C-H-A-O-Ndiagnostics.com.
You can follow Maecheon atTwitter at Machion DX.
Be sure to subscribe to stay inthe know.
Share this podcast withclinicians you think might
appreciate it, and we hopeyou'll join us next time here at
Blood Sweat and Smears.
Hello and welcome to Blood, Sweat, and Smears, your
Maecheon Diagnostics podcastwith tag team hosts, including
our medical director, Dr.
Brad Lewis, Senior DirectorBjorn Stromsis, that's me, and
other guest hosts.
We hope you find these podcastsinteresting and informative.
Thank you for listening, andaway we go.
(00:28):
Hi, my name is Bjorn, continuingour series Five Questions,
posing five questions tophysicians in and around the
disease areas we work in.
Today we are joined by Dr.
James Malone, Clinical AssociateProfessor of Hematology at
Stanford Medicine.
That's right, straight onclassical hematology.
We are also joined by Coloneland Command Surgeon James Malone
(00:50):
of the U.S.
Army Reserves.
Huah, and thanks for joining ustoday, Dr.
Malone.
SPEAKER_00 (00:57):
Mega Hua to you, Bjorn.
Thanks for having me honored andpleasured to spend some time
with you and uh and answer a fewquestions, hopefully, that are
of interest to our mutualaudience.
SPEAKER_01 (01:08):
Okay, on to our first question.
I know you've done a shift inhospital administration in your
career, and I'm wondering howbeing a physician informed how
you approached your work as anadministrator.
SPEAKER_00 (01:21):
No, thanks for asking that question.
It's increasingly a commoncareer path or way to blend both
sides.
I learned a lot about leadingsmall teams and leading
hospitals in the Army and foundit a natural transition to blend
what I did in hematology withwhat happens in the hospital and
(01:42):
healthcare system.
You know, one of the things thatI found was key was to continue
to do both things.
It's challenging to do that.
You know, when one becomes achief medical officer of an
acute care hospital, thebandwidth of time to then being
an active clinician stilldiminishes greatly.
But I found it was reallyimportant to be present
(02:06):
clinically to your colleagues inorder to be able to influence
what they do and don't dorelative to hop operations,
quality and safety and service.
So I never stopped being aclinician, mostly because of
that, also because of just purelove for hematology.
(02:27):
I can't imagine giving it up inany fashion.
SPEAKER_01 (02:31):
That's what we like to hear.
So, second question is how didyour time as an administrator
inform your work as a practicinghematologist?
SPEAKER_00 (02:40):
That's also a great question.
You know, when we trainresidents and fellows, we always
focus on things that we callsystems-based practice.
And that really means how welldoes one understand and use all
of the tools of healthcare?
You don't really understand andlearn that until you start
(03:01):
dipping your toes into theoperation side of how healthcare
runs, and particularly ahospital.
So I spent countless hours inevery department of a hospital
understanding how they worktogether and how they don't work
together.
And one of the things I reallylearned, and this was cemented
home during COVID, is thatpeople didn't understand how the
(03:22):
laboratory works and howimportant laboratory medicine
is, how useful it can be, howmuch it can be misunderstood and
misused and misunderstood.
So I really became a much betterclinician and particularly able
to train the next generation ofhematologists by really
(03:42):
understanding how a hospitalworks as an organism.
And that's really how I how Isee a hospital.
It's no different than the humanbeing.
It's got all these differentdepartments or organs that work
together, hopefully, sometimesdon't.
And the better we understand itsstrengths and weaknesses, the
more we can help others do thesame.
So those two have really gonehand in hand.
SPEAKER_01 (04:06):
And we didn't pay you to hype up the lab there.
SPEAKER_00 (04:10):
So just so everyone knows that.
No, negative.
I've I've always told everybodyI'm a I'm a laboratory
professional at heart.
You know, a good portion of myearly career at Stanford was as
the associate director of theBlood Bank and Transfusion
Service as well as Special CoagLab.
So I've always been a kind ofhalf clinician, half clinical
(04:32):
laboratory uh specialist, andalways always tell everybody I
work with that's often where myheart lives.
Fantastic.
SPEAKER_01 (04:40):
Yeah.
All right.
Third question.
So you split your time betweenStanford and the U.S.
Army.
And what do you experience asthe strengths of those two, and
I'm assuming here, verydifferent worlds?
SPEAKER_00 (04:51):
Yeah, it's an interesting shift.
I was, you know, just recentlyover in an area that the Army
has a big role in, which iscalled Central Command or
CENTCOM, which is thetraditionally what people know
is the Middle East, basicallybeing a chief medical officer
there or Army healthcare assets.
And people might think thatthere's not really any
(05:12):
parallels, but really theday-to-day key tasks and skill
sets are exactly the same.
You have to understand howcomplex systems work.
You have to be able to leadsmall teams, you have to be able
to know what your mission is andwhat your desired end state and
(05:32):
goals are.
Otherwise, you can really getlost out there and put in a lot
of effort, a lot of work, andnot accomplish a lot.
So I think really the the keythings that tie the two together
are the importance of teamworkand particularly in person.
This world of remoteness thatyou and I are doing right now is
great for a lot of things, butthere's nothing that substitutes
(05:56):
for just being in the trencheswith each other.
And that's the same whether I'mover there in the desert or
whether I'm on the inpatientconsult service at Stanford.
It's being present to developrelationships, to lead teams is
the thing that you need todevelop acutely to be able to
succeed in either of thoserealms.
SPEAKER_01 (06:17):
Great.
We recently were able to assistin a case you had while
deployed.
Can you share any of thatexperience?
SPEAKER_00 (06:25):
Yeah, I sure can.
You know, the I can say my 30years in the Army, I've probably
been used as a hematologist lessthan a handful of times.
People always ask me when I showup at a at a new base or a new
location, well, hey, sir, what'syour specialty?
And I joke around, I say combathematology is what I do.
And once in a while I do getcalled for that.
So in the midst of the conflictand the war between Iran and
(06:49):
Israel recently, I was notifiedthat one of our U.S.
service members was gravely illin a civilian hospital in the
Middle East.
And it just so happened thateverything I was told over the
phone made it sound like atypical HUS or TMA that was
going on.
So right when uh the conflictended, six hours after that, I
(07:12):
was on a plane to the countrywhere this soldier was to go to
the bedside and help diagnosewhat was what was happening.
And it was really clear to methat that this poor individual
had a severe life-threateningthrombotic microangiopathy, and
it wasn't clear why this was.
I spent a few days ruling outthe things that I could rule out
(07:34):
there, but then the thought cameto mind that geez, I think I I
need some special teams players.
And of course, you know, Mechiandiagnostics came to mind of
helping me understand that thisthis gentleman have an inherited
tendency to develop thisproblem.
And uh I was able to draw bloodspecimens from him and Bjorn,
(07:56):
with your and your team's help,able to rapidly get a TMA
genetic panel done, which wasvery instructive in telling us
that yes, indeed, thisindividual had a known risk
factor for developing thisproblem and we had the right
diagnosis.
Unfortunately, despite all ofour best efforts, he he died of
his underlying illness.
(08:17):
But it was critical to be ableto tell his family, and
particularly his one survivingbrother, why we thought his
26-year-old brother slash sondied of illness uh while on
active duty in the service ofhis country, and to be also
share with them that, yeah,there is a genetic predilection
(08:37):
that we should pay attention tofor his brother and also other
members of the extended family.
So it was it was critical to beable to have that worldwide
reach of the expertise andtalent that Mechan presents.
And I'm forever thankful to beable to just reach out to you
and your team by any meansnecessary and get that
assistance.
SPEAKER_01 (08:58):
Well, we were very honored to play a small role.
All right, our fifth questionclassical hematology often
doesn't get the respect itdeserves.
So, what would your elevatorpitch be for your subspecialty?
SPEAKER_00 (09:14):
I would ask the person in the elevator, tell me
the most common laboratory testordered in the United States
annually.
And I bet you, even if theydidn't know, they could guess.
It's a CBC, right?
So, therefore, there's so manyopportunities for classical
(09:34):
hematology to get involved inthe care of just about any
patient because routinely you'regonna find some abnormality
there that needs someexplanation and understanding,
and that's often the window intoso many other disorders and
diseases that the patient has.
So it's it's again, it'ssomething that every
(09:55):
practitioner looks at regularlyin their patients, but
understands often the least.
The other pitch I would givethem is that we are about the
busiest consult service in thehospital.
We routinely carry over 20patients on our inpatient
consult service, ranging fromlabor and delivery to the
(10:17):
emergency department, cardiacICU, pre-op surgical area,
medical teams, solid organtransplant, and bone marrow
transplant.
There's no corner of patientcare where classical hematology
doesn't touch.
And we're a huge enabler of allthese other important
life-saving services.
(10:37):
We're constantly trying to tellStanford Medicine how important
we are.
Of course, we pat ourselves onthe back every day and try to
share with them our impact.
But really, classical hematologyand systems-based hematology is
critical to the ability to runtertiary and quaternary care
centers.
It's not possible to do itwithout expertise on site.
(10:58):
And that also includes expertisein laboratory diagnostic
services.
SPEAKER_01 (11:03):
Fantastic.
So if you're keeping score athome, that is five questions,
which brings us to our bonusquestion.
And that is what is somethingyou'd recommend?
And it can be absolutelyanything.
SPEAKER_00 (11:20):
Do things occasionally that are way
outside your comfort zone.
One of the sayings I heard along time ago that I try to
subscribe to is you know, lifebegins at the end of your
comfort zone.
I constantly try to put myselfin little situations that are
not particularly of high risk tomyself or others, but that make
me uncomfortable.
Because it's only when I do thatthat I start to learn about
(11:44):
myself, about others, and aboutthe world.
So I would say get out there,get a little bit uncomfortable,
and you'll actually be betteroff because of it.
SPEAKER_01 (11:54):
Yeah, it's great advice.
Uh, and while this conversationwas well within my comfort zone,
I'll look for an opportunityhere shortly to get outside of
it.
Thank you very much for yourtime today, Dr.
Malone.
Really appreciated your commentsand your words.
SPEAKER_00 (12:13):
I'll just say in closing, you know, one of the
things that I think we have incommon in the Army and your team
has in common with us is ourapproach to our work.
You know, we always say missionfirst, people always.
But that's also the sameapproach that you and your team
take to your work.
SPEAKER_01 (12:31):
Very much appreciate it.
Thank you very much.
SPEAKER_00 (12:33):
Absolutely.
SPEAKER_01 (12:35):
That's it for us here at Blood, Sweat and Smears,
a podcast produced by MachionDiagnostics, your reference lab
and CRO specializing inthrombosis, hemostasis, and rare
disease.
Thank you for listening.
And if you have a question orcomment or there's a topic you'd
like Dr.
Lewis to speak to, please sendus an email to BloodSweat and
Smears at MachionDiagnostics.com.
(12:57):
That's M-A-C-H-A-O-Ndiagnostics.com.
You can follow Maecheon atTwitter at Machion DX.
Be sure to subscribe to stay inthe know.
Share this podcast withclinicians you think might
appreciate it, and we hopeyou'll join us next time here at
Blood Sweat and Smears.
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