Worth Fighting For

When it comes to digitization, pathologists are late to the party.

A decade or two ago, radiologists realized that they could get rid of their nasty chemicals and heavy, expensive, silver-laden films (which had to go into great big packets for preservation, be carted around the hospital, and be put on lightboxes for MDTs). For them, digitization seemed the obvious solution. Of course, there was a bit of resistance at first from people who worried about the quality of the images – but now, with modern monitors, it’s clear that isn’t a problem. But radiology had one major advantage over pathology: they save a lot of money by doing digital work instead of chemical use, film production, and physical storage. Pathology’s digitization is not instead of; it’s as well as, because we still have to make slides, stain them, scan them, and usually keep them for medico-legal reasons even after creating a digital version.

There are, of course, huge advantages in terms of workload distribution and archive accessibility – no more digging through a room full of glass slides to find a single image – as well as enabling use to apply artificial intelligence software. Unfortunately, in our case, we’re not saving anything; we’re paying for these advantages. And that’s particularly difficult in the resource-challenged environment we all live in at the moment. There’s not enough money in healthcare to do everything patients need, and the laboratory often ends up last in the queue. If there’s something we truly need, we have to fight for it.

Is it worth fighting for? I think so. In the North of England, where I work, we have a shortage of medical hematologists and specialist biomedical scientists to cover out-of-hours provision of morphological expertise with compliant sustainable on-call rotas – particularly in the region’s more remote hospitals. For example, a biomedical scientist from biochemistry in one of those locations might need support at two o’clock in the morning, faced with the prospect of looking at a blood film they don’t fully understand. Can we help out? Until now, we’ve solved that problem either by expecting the local hematologist to come into the lab in the middle of the night and look at the slide or by putting the slide into an urgent taxi to one of the larger institutions.

These options become less sustainable in the light of rota requirements, recruitment problems, locum availability, and the cost of locum cover. But the provision of a robust diagnostic hematology service is critical for the operation of any hospital providing a 24-hour acute service. Suddenly, you have a problem that interests administrators – and a potential argument for resourcing an alternative. We have been able to obtain pilot funding for scanners on the basis of out-of-hours blood film reporting (and using the opportunity to explore daytime use as well); others may have different reasons. It’s a matter of finding a problem that people are prepared to throw some money at!

Some time ago, I met a Californian couple who had originally come to England for a year’s sabbatical to accommodate the wife’s career as an academic historian. The husband, a senior radiologist, had taken the year off work – but, when the move became permanent, he needed to find a job. It turned out that his hospital in California was struggling to get radiologists to report cross-sectional imaging on patients at night. Thanks to digitization, he was employed full-time during his day to report overnight scans eight time zones away. One day, I hope the same will be possible for pathologists and laboratory medicine professionals worldwide.