Response to “Pathologists Cannot Talk to Patients? Fuggedaboutit”

| November 20, 2014

Perhaps not too surprisingly, there was a pretty good response to my post towards the end of last month entitled “Pathologists Cannot Talk to Patients? Fuggedaboutit”.

And also not too surprisingly given the issues I raised the battle lines are largely drawn between pathologists and clinicians.

Most pathologists that commented, e-mailed or shared their thoughts on other social media outlets already incorporate some direct patient communication within their practice in many forms, through direct reporting of fine needle aspiration (FNA) results at time of pathologist-performed FNAs, as a resource for patients with questions about their histopathology diagnosis and/or as laboratory medical directors. Of course none of these folks practice in New York state.

The discussion remains popular on the Sermo message boards with many comments from pathologists, oncologists, surgeons and others. For the most part, clinicians question why a pathologist would like to talk to a patient and think discharging the responsibility (and liability) to the clinician should be regarded as a positive for pathologists with the exception of oncologists who largely do not discourage their patients from speaking with a pathologist regarding questions of differentiation or stage of their tumors.

Several physicians from multiple specialties asked why the government was even getting involved in this and questioned if the law would survive a legal challenge.

Unfortunately, there were a few pathologists, including a vocal one on Twitter @SurgPath Atlas who uses the byline “pathologist extraordinaire” that thought the law made perfect sense, we had no role in direct patient communication, that it woud be disruptive and time consuming without any benefit to his/her practice.

A few of his/her thoughts are below. Fortunately, I think SurgPath Atlas is in the minority and most of us do not feel the same way or anticipate what he/she describes. Agree, with 100s of cases, er, I mean patient slides, a week, discussing every single result with the patient, the customer, would not be possible, nor does it exist today for benign and/or gross only or anticipated benign (i.e. hernia sacs) diagnoses.

Nor do I think we can replace the clinician, I am merely suggesting we should be a patient resource on occasion to discuss their clinical laboratory or anatomic pathology results when consulted to do so. And our clinical colleagues and legislators should support the option to do so.

2014-11-19_20-01-18

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Category: Anatomic Pathology, Blogs, Clinical Laboratories, Clinical Pathology, Current Affairs, General Healthcare News, Government, Laboratory Management & Operations, Pathology News, Patient Advocacy, Personal

Comments (1)

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  1. Harold Evans says:

    I would like to briefly remind everyone of the benefits of collegiality and civility.

    As a pathologist I am part of a team who cares for patients. My primary role is to provide the team with the pathology information, obviously. The pathology information is utterly critical and the pathologic diagnosis is the ultimate driver of everything else.

    I have interacted with patients hundreds of times, as I did numerous FNA procedures during a cytopathology fellowship. I am very comfortable in that role, but I usually recommend that they discuss the results with my surgery or oncology colleagues. Those colleagues have more information on co-morbidities and are the ones who will formulate the treatment plan. This does not in any way diminish my role as a key member of the team.

    On the other hand, when appropriate, I may discuss the results directly with the patient. If results are obviously negative for an extremely anxious patient, for example. Of course I always remind patients that an immediate evaluation interpretation is preliminary and could be changed. I may share a malignant result with a patient who has experienced a lot of treatment and makes it clear that they realize their lesion is almost certainly a relapse. A couple of times I have supported a clinical colleague in discussions with a patient.

    It is really a bit similar to the role that radiologists play.

    There are many right answers, but all of the right answers involve mutual respect between pathologists and clinicians, pathologists and other pathologists, and physicians and patients.