Pathology as a Much Maligned Specialty is Not

| July 20, 2015

“Several studies have shown that the specialty of pathology tends to attract intuitive, detail-oriented introverts who appreciate the emphasis on intellectual ability and the lack of direct patient contact.”

H.L. Mencken said, “What animates a great pathologist? Is it the desire to cure disease, to save life? Surely not, save perhaps as an afterthought. He is too intelligent, deep in his soul, to see anything praiseworthy in such a desire. He knows from life-long observation that his discoveries will do quite as much harm as good, that a thousand scoundrels will profit to every honest man, that the folks who most deserve to be saved will probably be the last to be saved. … What actually moves him is his unquenchable curiosity—his boundless, almost pathological thirst to penetrate the unknown, to uncover the secret, to find out what has not been found out before.”

The full quote actually goes on to say “… [like] the dog sniffing tremendously at an infinite series of rat-holes. … And yet he stands in the very front rank of the race.”

The last sentence is not terribly flattering but I think it does pathologists more justice than saying we are a bunch of social introverts who like not having any direct contact with patients.

Perhaps I am being overly sensitive to the issue but I think what the public generally sees of pathologists is not flattering.

The Atlantic recently published a piece entitled “The Doctors Whose Patients Are Already Dead”. The story describes in somewhat inappropriate detail the work required for an autopsy and goes on to say “Pathologists think they’re the most maligned people in medicine”, quoting the pathologist as saying “We’re like the cockroaches.” And that the popular maxim of being “the doctor’s doctor” holds true today. The story also mentions “Within the medical field, though, pathologists are often stereotyped as cold and detached, even creepy: They’re the doctors who don’t like patients; the ones who would rather hang out in basement labs all day.”

Really? Better the general public not know who we are altogether then.

pathologyThe GomerBlog is, as their disclaimer states, is “strictly a satirical and fake news blog site.  All articles are fake and not intended to diagnosis medical conditions or to give medical advice.  Please see a real medical website or your doctor for diagnosis and any medical advice. Please don’t take any advice from our website. Our articles are not intended to be insensitive, or offensive, or to otherwise belittle those affected with any medical disease, condition, or illness.  We apologize if we have offended you, as it is not our intention.”

They make fun of all specialties, because as their “About Us” section describes, “Working in medicine is stressful!  Sometimes it just flat out blows as a health care professional. Our target audience is anybody working in or interested in the health care industy including ALL medical specialties. Gomerblog.com is a satirical medical news website created by a bunch of wannabe stand up comedians who ended up in health care.”

pathology2They have a post on their site entitled “Medical Specialties as Game of Thrones Characters”. For the specialty of Pathology, our character is best represented in the popular series by “…Ah…???” because “Exactly, nobody knows who you are. You’re at least as well-trained and skilled as everyone else, but seldom get the same respect others do; and you’re a little creepy.” So, we end up being Brienne.

Couldn’t we at least be Tyrion Lassiter who uses his wit and intelligence to overcome discriminations against us?

It is one thing for a satirical site to malign our specialty and personalities and generalize us but I think completely another for a publication such as The Atlantic to malign our specialty based on one autopsy experience and a few interviews.

The problem is we don’t really help ourselves change these stereotypes, real or fictional. How many of us perform community service with patients, or attend support groups for patients and their families to discuss pathology or lab testing or what services we can offer?

But does it really matter?

The problem is that the general public and patient public does not have an idea of what we do and many have little say in the matter and perhaps freedom to choose a laboratory or a pathologist may be more limited in the future.

When your doctor says “We will send this biopsy to the lab and call you with the results in a few days” do patients know or care at that point what lab or know to ask? Or when the clinician says “We use Lab X – please go get your labs drawn at Lab X” how many would question “Why am I going to this lab?”

While patients might research the physicians and hospital reputations, how many know to ask about other services such as pathology and laboratory medicine services that are critical to their care. Perhaps if the doctor and hospital are reputable, then surely the pathologist and his/her lab are reputable and trust their doctors are referring them to other reputable providers and businesses.

And perhaps that is what is most important – the relationships we have with our customers, our referring clinicians and patients in their care, administrators, vendors, suppliers and reference laboratories to insure we deliver the best care even if our clinical colleagues and patients don’t completely understand what happens behind the paraffin curtain in windowless offices in basements by a bunch of smart introverts.

It does matter.

A patient recently came to the lab with her breast surgeon asking to review her slides with a pathologist following the tumor board discussion. Before evaluating her options, the patient, a non-healthcare professional asked to review her pathology slides with a pathologist before proceeding with the treatment recommendations. She wanted to see for herself the tumor, margins and other pertinent findings. Ultimately she decided upon following the recommendation of the tumor board and made an effort to personally thank the laboratory and tell the administrators how appreciative of the pathologist and pathology department she was.

And this is what our specialty represents. And what the majority of us do and appreciate doing for patients but are not often provided the opportunity with our clinical colleagues and our patients.

Although the patient was a little surprised we weren’t in the basement, actually had windows in our offices and could be so talkative!

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Category: Anatomic Pathology, Clinical Laboratories, Clinical Pathology, General Healthcare News, Pathology News, Patient Advocacy, Personal

Comments (3)

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  1. We read with interest Dr. Kaplan’s insightful take on the “GomerBlog” and “The Atlantic”‘s askewed Odin-eyed view of the pathologist as a doctor, “whose patients are already dead”. Far from the truth, we agree.
    True, we look at the microscope day-in day-out, not just out of insatiable canine-like “curiosity” as HL Mencken boorishly assumed, but just like any doctor worthy of his stethoscope, and who had sworn The oath, we believe in helping people as patients and above all “doing no harm”. Our patients are well and anxious, eagerly waiting for their diagnosis, not as cold, dead, or in line for Dr. Quincy’s knife. We render diagnosis as honest, heartfelt,and as caring as we can, because we know, and God forgive me by assuming we all do, it is not just dead tissue we see that is on the line, but a real person, who consented to the biopsy, and whose life potentially will be or is forever impacted by any diagnosis, the companion therapy, and their associated risk and survival.
    I do not think we, as pathologist, are “the Brienne” or even “the Tyrion Lanister”‘s of the fabled Game of Thrones saga, nor are we the keepers of the wall-the Black against the white blue-eyed walkers, although I would give ground, that from all of these archtypes, we do share some flattering traits of loyalty, smartypantsness, and oathkeepingness to our live or to be pertinent, our dead patients. I am biased, beg pardon to the metaphors, that pathologists are descended from the honor-bound souls of true rulers of Winterfell.

    Pathogists talk with real people the world over to help with their concerns,hand in hand with “real” doctors, via telemedicine, via HealthTap concierge and other APPS.

    Good day and good luck.

  2. The Alchemist says:

    We’re clearly Hallyne from Game of Thrones.

    Wait? Who’s Hallyne??!

    Hallyne is the pyromancer who developed and stewarded over the tons of wildfire that was instrumental in the Lannister victory over Stannis Baratheon.

    Without Hallyne, the battle would have been lost, and the citizens of King’s Landing would be tied to pyres in sacrifice to the Red God.

    It fits: he’s odd as Hell, singlemindedly concentrated on the one thing he knows about but absolutely socially useless otherwise, that one thing he knows about he knows extremely well, and because of his knowledge the day is saved, yet others take the credit.

    That’s pathology.

    Pathology is Hallyne.