An Identity in Danger

The article “Our Own Worst Enemy” will undoubtedly give rise to many opinions on pathology’s future. As someone who has been around for quite a few years, I would like to share something the article did not consider.

The most telling sentence in the article is, “We need a distinct place in the medical curriculum that shows pathology as a clinical specialty.” During my time in medical school (1969–1973), such a “place” was available – but pathology departments never knew how to take advantage of that place and certainly never used it as a specialty recruiting tool. Our pathology course ran for eight months during the second year. It was a comprehensive tour de force that gave me great respect for pathologists. However, there were two reasons I didn’t consider pathology as a career. The first is that pathology departments never made a concerted effort to show medical students that pathology is a clinical specialty choice. The impression I had was that pathology, stuck as it was in the second basic science year, was simply another of the basic sciences. Most of the pathologists who taught us in medical school seemed to spend their time teaching, doing basic research, or performing autopsies. That meant, by default, that all the professors we met in pathology were not clinicians. Clinicians were the professors we met in third- and fourth-year clerkships and they were the physicians to be emulated. Pathology helped prepare medical students for those clinical years, but was not an integral part of them, reinforcing the feeling that the third and fourth years were what being a doctor was all about. The second reason is that nowhere in either the traditional or revised curricula are students exposed to actual pathologists doing their everyday jobs. Without this exposure, there can be no pathologist role models to emulate.

In my fourth year of medical school, I was in a quandary about what specialty to pursue. I liked all my clerkships, but somehow none of them fit my interests enough to make me desire a career in any of them. I knew that I enjoyed making diagnoses more than treating them. I expressed this to my faculty advisor, who was smart enough to figure out that I might enjoy a career in pathology. My advisor and a surgical pathologist friend of his helped me arrange an elective in surgical pathology at another medical school. No student from either my own medical school or the school where we arranged the elective had ever done what I was about to do. It turned out that the surgical pathologist was not just a brilliant diagnostician, but also an incredible role model. By the time I had finished half a day of the elective, I knew I wanted to spend the rest of my life doing surgical pathology.

And that’s exactly what I have done from that time until now – an interval of 49 years. During much of that time, I have tried to be a resource for medical students interested in pathology. I think the single most important thing I ever did in this regard was formulate a surgical pathology elective students attended either individually in their fourth year or as a group in their second year, allowing even second-year students to understand the active role pathologists play in clinical care and that pathology is a viable career. This was done at a time when systemic pathology courses had become absorbed into systemic interdisciplinary courses and pathologists were losing even more of their identities to new curricula. If we do not address this identity loss, one day there will be no identity.