Come Together

It feels like a long time ago that I graduated from a prestigious orthopedic pathology fellowship at New York’s Hospital for Joint Diseases (now NYU Langone Orthopedic Hospital). I had a great time working with my mentor, German Steiner, and occasionally attending the old New York Bone Club with internationally recognized orthopedic pathologists, including Peter Bullough, Howard Dorfman, and Michael Klein. It was a privilege to work with these old-school gentlemen – but not just because we became friends; the Bone Club is also the place where I learned how important it is to work as a team with my clinical colleagues.

I remember Samuel Kenan, an orthopedic oncology surgeon who did an orthopedic pathology fellowship with German Steiner. He regularly came to the frozen room during surgery to discuss the case with pathologists. I found out that was a great way to get all the clinical information – we could ask him any questions we had and he could do the same to us. It definitely helped us to come up with the best possible answers for each patient. From that time on, wherever I went, I tried to form good relationships with my clinical colleagues – and, over time, it worked wonders.

These relationships can’t be formed overnight, though. Each time I moved to a new institution, I had to start building an orthopedic pathology service from scratch. Both times, though – at the University of California Davis and at Loyola University Chicago – I found a great team of knowledgeable, intelligent, and friendly colleagues in musculoskeletal radiology and orthopedic oncology surgery. I follow “Jaffe’s triangle,” a concept first published by Henry Jaffe in 1958, in which the orthopedic surgeon, the radiologist, and the pathologist all share their points of view on a bone lesion to form a rational diagnosis.

This approach is especially important in bone sarcoma teamwork. In most cases, the pathology team receives only small fragments of bone – a challenging diagnostic puzzle unless you can correlate the samples with radiological and clinical findings. For example, differentiation between enchondroma and low-grade chondrosarcoma is not always possible on a histological level. However, if you combine histology with tumor size and local behavior, you can come up with a more definitive diagnosis. If, for instance, I see that the tumor involves bone cortex, my diagnosis will favor low-grade chondrosarcoma over enchondroma – a distinction I would not be able to make without radiological and clinical correlation. It’s cases like this that showcase the importance of an interdisciplinary, collegial approach to diagnosis.

By building the trust and respect of your clinical colleagues, you create a foundation that will serve you well in your clinical work. Interdisciplinary teamwork not only helps you in daily practice, but also has a positive impact on patient care. By combining all the information in a timely, friendly manner, you and your team will provide faster and more accurate answers for your patients. After years of working in this way, I see only positives to an interdisciplinary approach to patient care – and I’ve built successful orthopedic pathology practices and made many friends along the way.