Creating a Living Textbook
Sitting Down With… Nat Pernick, Founder and President of PathologyOutlines.com, Bingham Farms, Michigan, USA
Michael Schubert | | Interview
How did you end up in the world of pathology?
My first love was computers. I started programming in the early 1970s, initially with an Olivetti programmable calculator to keep score in bowling. After my calculus teachers taught me BASIC, I started working for Wang Laboratories as a programmer. Then, I got a job from my girlfriend’s uncle – creating a LIS for his clinical laboratory. Because I also loved science, my girlfriend convinced me to consider medicine. I attended medical and law school at the University of Michigan with a planned career in the promised new field of “computers and medicine,” which was never established. I practised law for several years, but didn’t find it exciting. Eventually, while talking to some medical school classmates at a summer camp, the idea of becoming a pathologist took hold because I like to understand how things – and people – work.
How have you combined your experience in medicine and law throughout your career?
As a law student, I clerked in a healthcare legal department and was told that I would look back on my medical school education as “a complete waste of time.” After many law firm interviews, I decided to work for myself. I did all types of law, but ended up handling debt collection, primarily for the State of Michigan – things like student loans and taxes. Today, my legal background is helpful for the business aspects of PathologyOutlines and understanding how the world works.
You are best known for your website, PathologyOutlines.com. What inspired you to create such a resource for pathologists and laboratory medicine professionals?
The inspiration for the website started with David Grignon’s unknown conferences coupled with John Sinard’s book, Outlines in Pathology, which residents constantly updated by taping sheets of paper into the book. After residency, I decided to compile all of my books, atlases, handouts, and notes into an online database that would be readily accessible to me and anyone else who might find it useful. My “mission” was to help pathologists, including myself, do a better job by making the information we need fast and free to obtain. I started writing, initially with the thyroid chapter, at the same summer camp where I had first made the decision to pursue pathology.
How did you set up PathologyOutlines.com?
A friend who designed websites set up the main structure. I wrote chapters in Microsoft Word, saved them in HTML, and uploaded them. It was quite simple at first. At some point, I realized that it made sense to invite people much smarter than I to write for the site. Later, Debra Zynger suggested starting an editorial board – and helped me set it up, because I did not speak “academic.”
I consider this textbook an almost impossible task due to its vast scope – but my philosophy for difficult tasks is simple: start and keep going. I think it is successful because I can say two things many others have difficulty with: “I don’t know” and “I was wrong.” This is necessary, in my opinion, when doing something that has not been done before. I asked a lot of people for advice and made a lot of mistakes, but I learned from them and kept things moving in the right direction. It also helped that I am an idealist, committed to the cause, and don’t care as much about money as others.
Have you noticed any trends in subjects of interest for pathologists over recent years?
For jobs, Debra Zynger and I analyzed our advertisements and found trends towards molecular, dermatopathology, and GI jobs (1). I write papers on How Cancer Arises Due to Complexity Theory (2) and personally think that biologic networks, complexity theory, and self-organized criticality will become “hot topics” as we move toward curative strategies for adult cancers.
You have an extensive CV and a busy website. How do you balance your personal and professional lives?
I try to compartmentalize my time for the website, research, and personal life but it often gets jumbled. I have found that vacations – even just long weekends – are a good opportunity to “restart” my life by planning each day the way I want it to be. That way, the “new normal” is established by the time I go back to work. I have also learned from others that starting the day at 4:00 a.m. (when I can do it) makes me more productive.
If you hadn’t become a doctor – and then moved into running PathologyOutlines.com – what would you be instead?
I loved computers and was very happy doing that. In fact, I worked as a programmer to pay for medical and law school and even as a resident.
What advice would you give to pathologists and laboratory medicine professionals who are just starting out in the field?
Act in the best interest of the patient, even if it causes trouble for you personally in the short term. Also – try to get along with everyone… even the difficult people.
- DL Zynger, N Pernick, “Understanding the pathology job market: an analysis of 2330 pathology job advertisements from 2013 through 2017,” Arch Pathol Lab Med, 143, 9 (2019). PMID: 30785304.
- N Pernick (2021). Available at: https://bit.ly/3jQKrJu.