Pathology is Hogwarts

Recently at a golf outing sponsored by our hospital system, I met another physician in my group I had not met before. I had recognized his name from medical records and occasional orders for biopsies or fluid examinations but with thousands of physicians in dozens of hospitals one cannot know everyone.

As doctors do when they introduce themselves, he gave me his name and specialty (Internal Medicine). I did the same, “Keith Kaplan – Pathology”.

To which the internist responded “No sh*t! You are the Kaplan in Pathology.” Unless there are two of us, I told him, it was probably me.

The internist went on to say “Pathology is like Platform 9 ¾ !”

“Excuse me?” I responded.

“Yeah, you guys in Pathology are like wizards working in the basement in dark holes giving us the answers. You are essential to what we do but nobody exactly knows how they hell you do it.”

“Pathology is Hogwarts”, the internist continued.

I hadn’t thought of Harry Potter and his friends and enemies and that game they played on flying brooms and wizards and sorcerers and “he who shall not be named” for many years. I enjoyed the movies over the years, but some time has passed.

“Hogwarts like Harry Potter and Hogwarts?” I questioned after a short pause to collect my thoughts. The internist replied of course it was that Hogwarts.

“Then what does that make Internal Medicine?”, I asked.

“We are muggles”, he responded. “We don’t have the powers pathologists do. You get tissue on a slide and tell us what it is. Then we open up a cookbook and follow the recipe”, Dr. Internal Medicine continued.

All of this was a fun metaphor and not too dissimilar from previous analogies and metaphors about the odd, unusual, eccentric, introverted and poorly understand area of medicine, even among seasoned doctors and other healthcare providers in terms of what pathology is and what pathologists do.

I added, “You know, technically, we are not in the basement working under green lights with secret potions. The laboratory is on the first floor where we do our magic and keep it from you muggles.”

The internist shot back “I tell my patients all the time when they ask me about their biopsy result or surgery specimen that I am not going to call you guys when they are waiting for an answer.” He continued, “I tell my patients they don’t understand what goes on in the laboratory – I am not going to bother the pathologist who is looking through a microscope to tell you what the diagnosis is and interrupt that and just delay things longer.”

I shared with him that was an interesting perspective and one I had not heard before, but while trying to focus on getting ready for this golf tournament to make my department proud, appreciated that it seems over the past couple of years there have been fewer calls about cases. It may be with same day IHC and great transcription and support services that we have with more in-house testing for molecular and FISH, turnaround time expectations are being met.

“Interesting you say that, I just had a kidney biopsy I received at 4 in the afternoon the other day and someone called me at 9 the next morning to know what it was. You know, those require H&E and special stains and direct immunofluorescence and electron microscopy. That takes a little time. You seem to understand that.”

The internist shot back, “No I don’t understand that at all. I told you that. I don’t know how long it takes but I remember carrying my microscope and slide box around in medical school thinking I wouldn’t want to do this for a living and was just trying to pass histology and pathology to get an internal medicine residency. That is the point — Pathology is Hogwarts.”