The pathologist-patient relationship – does it exist?

One of the arguments against using telemedicine is that it damages the physician-patient relationship.  For a patient-contact specialty, never having the chance to touch your patient s probably impairs your ability to diagnose and treat them.  Beyond the art of physical exam, establishing a personal relationship between the one who suffers and the one who professes to have the knowledge and skill to heal is needed for a true therapeutic bond.  So perhaps telemedicine doesn’t work well for what we’ve traditionally understood as primary care and the patient-contact specialties.

But it might be fine for pathologists.  Especially if you believe that the pathologist’s obligation is to the physician seeing the patient.  Then it may not matter where we review their material.  After all, don’t we send cases to Hopkins or Mayo in order to get an “expert” opinion?  In fact, if there’s no need for a relationship between the pathologist and the patient, then maybe pathologists don’t need to be physicians.  Maybe we could be histomorphologists.  Or molecular analysts.  We could be skilled technicians who are adept at categorizing abnormalities that we detect in patient samples sent to us by physicians caring for the patient.

Or not.  I would argue that pathologists must be physicians because our primary obligation is to the patient.  Our obligation is to help the patient first, regardless of insurance pressures, surgeon intimidation, political expediency, or whatever might get in our way.  Just like we said we would when we took the Hippocratic Oath.  If you look at the surgeon/dermatologist/gastroenterologist as a surrogate for the patient, asking for your help in the patient’s stead, then the pathologist-patient relationship makes sense and can serve as a starting point for looking at new ways to practice our specialty.

Dr. Cruser is a practicing pathologist in New York. 

This line of thinking goes contrary to what most of us were taught in residency and I think were taught early in practice – that we serve as the Doctor’s Doctor rather than the Patient’s Doctor but this is where pathology finds itself now in combating public perception and payor perception.  At one point the notion of the Doctor’s Doctor sounded like a good idea rather than the pathologist being part of a clinical care team. More on this in a future post.