What is to become of the general surgical pathologist?

There was a story in the New York Times yesterday entitled "Prone to Error: Earliest Steps to Find Cancer" (Tuesday, July 20, 2010) written by Stephanie Saul, a Pulitzer Prize winning investigative journalist.  There is also a 7 minute video that accompanies the article produced by Shayla Harris, an award winning video producer with the New York Times.  

In short, the article deals with examples of errors in breast cancer diagnoses and personal stories of women affected including a case involving a misdiagnosis lawsuit.  

The video mentions the "American College of Pathology" I think referring to the College of American Pathologists, refers to pathologists "helping doctors diagnose cancer" while we "work in a lab rather than seeing patients".  It also says that the biopsy samples may be the size of a "few grains of salt".  

There are some excellent comments by Dr. Shahla Masood (note the clipboard and seeing a patient in her web profile picture) and reference to a certification program for breast pathology credited to Dr. James Connolly citing possible financial implications for referrals to "breast pathologists".

There is no doubt this is a confusing area of pathology, even among experts as the story points out, and no one likes to hear about adverse outcomes and second and third opinions in some cases may be warranted.

This brings up a number of complex issues and the story is not favorable to pathology or pathologists.  The "American College of Pathology" and a "few grains of salt" and call out a pathologist who did obtain a second opinion?  Come on.  

Nonetheless, the story highlights errors made out of "hundreds of thousands of breast biopsies performed in this country a year", presumably from imaging guided biopsies detected from screening mammograms.  The debates continue about appropriate screening.

One mistake is too many but in my opinion the story puts pathology in a bad light and will only further undermine patients' confidence in the accuracy of their testing and diagnoses.  

I don't know which is worse the public thinking all pathologists are like "Quincy" or worse, like Dr. Kevorkian or have anything at all to do with the movie "Pathology" or this.   

Today, the CAP (aka "American College of Pathologists) sent a letter to the editor of the New York Times addressing pathologists’ commitment to continually improve the accuracy of diagnosing DCIS.

Having spent enough time in small community hospitals by myself for periods of time as a part-timer in doing so, I have a lot of respect for those folks who do it as a career without immediate "next door experts" or having renown "experts" in your department as I have enjoyed.  Add to that problems with classification and reproducibility and a drive towards one having their own "breast radiologist", "breast oncologist", "breast surgeon" and "breast pathologist" – what is the general pathologist to do?  And what happens when your "breast pathologist" is on vacation or at a "breast meeting" and these cases come across your microscope?

It is a delicate balance with significant push-pull involved with sub-specialty designations.  

And what are we as patients to do?  Go to cancer centers or specialty hospitals and seek out internal medical sub-specialists or surgical sub-specialists bypassing generalists and community hospitals?