It’s Time to Talk
The life-changing impact of patient-pathologist interactions
Jeffrey Myers, Lotte Mulder, Michele Mitchell | | Longer Read
Pathology plays a key role in patient care – from diagnosis to treatment and beyond. But despite pathology’s importance, few patients are aware of the discipline. Knowing more about the laboratory empowers patients and improves their health, and patient-pathologist interactions can enrich the lives of both parties… so laboratorians should strive to make contact.
Patients’ lives depend on pathology. It is through accurate and timely diagnostics that medical teams are able to treat, manage, and even cure patients’ illnesses and maintain their health. Indeed, without accurate pathology and laboratory medicine systems, healthcare systems would fail, leading to enormous economic and personal losses (1,2,3). However, despite pathology’s critical role in high-quality patient care, most patients are unaware of what pathologists do and why they are so important (4).
Why are patients so much in the dark about such a vital specialty? There are a variety of contributing factors. For one, laboratory reports rarely include the name of the pathologist (5). Additionally, when clinicians communicate directly with patients in reference to diagnostic medicine, they often refer to “the lab” rather than to the pathologists issuing the diagnosis. As a result, many patients view “the lab” as a sort of black box that takes in samples and churns out answers, rather than as a collection of highly qualified doctors and laboratory medicine professionals
“With the expansion of immuno-oncology treatments available to patients for a myriad of diseases, the role of the pathologist is evolving. Not only are pathologists involved in diagnosing patients, but they are also involved in treating patients – which many have referred to as ‘therapeutic pathology,’” says Kim Sanford, ASCP President-Elect and Associate Professor of Pathology at Virginia Commonwealth University.
Understanding the role pathology plays in an individual’s healthcare is incredibly empowering. Knowing what lab tests mean, understanding which values are good and which are cause for concern, and knowing why certain tests are used can help patients feel more in control. It also provides them with a deeper understanding of their diagnosis and treatment plan. These are all aspects that can make a difference in overall health – and can enhance awareness of pathologists and their work.
One of the authors of this article, Michele Mitchell, was diagnosed with breast cancer on the same day that her husband, Ray, suffered a stroke. Ray passed away a month later. Michele went through surgeries, chemotherapy, radiation, and adjunctive therapy, but it wasn’t until midway through her treatment that she met co-author and pathologist Jeffrey Myers. And that’s when she first understood that she could see her own pathology report and actually speak with a pathologist about her case. He showed her the tumor slides and pathology report, and it changed her view of her disease.
The meeting helped Michele better understand her diagnosis and treatment plan and embrace the necessary steps to beat her cancer. She framed the cancer slide and now keeps it on her dresser at home. She says, “I look at it every morning so that I start my day with a re-commitment to living a healthy lifestyle.”
Pathology touches the lives of nearly every patient who steps through a healthcare organization’s doors, and although the specialty has traditionally lived behind a curtain (seemingly beyond the reach of patients), stories like these show that the paradigm is shifting.
Putting patients first
Patient-pathologist interactions can have a profound impact on both parties. Patients gain an increased understanding of their specific circumstances and treatment plan. If they have a life-threatening diagnosis, they can also form a clearer image of what exactly they are fighting. Pathologists, on the other hand, can understand how they impact patients’ lives and increase their sense of purpose and accomplishments. As pathologist and ASCP Past President Jim Wisecarver states, “From a personal standpoint, having had the opportunity to work directly with patients during various types of apheresis procedures has reminded me that I, too, am a physician. Managing fluids and medications, consulting with their primary physician, and ultimately watching them improve clinically as a result of our efforts is very rewarding.”
To better facilitate patient-pathologist interactions, some healthcare organizations today are adopting a patient- and family-centered care (PFCC) strategy. Not only do such strategies encompass clinicians working directly with patients and families in the context of an episode of care, but they also extend to how facilities are designed, how policies affecting care are developed, how quality can be achieved in our daily work, and how we respond to patient safety events. When pathology and laboratory professionals learn to interact directly with patients and families in all aspects of their work, it results in greater success. Moreover, the practice sets up an improved patient experience that impacts not only individual, but also the health of the community. Implementing PFCC in your own practice begins with first learning what resources are available at an institutional level. This might include opportunities for active participation in an enterprise-level Patient and Families Advisory Council rather than creating your own. Either way, this is more easily done in partnership with others than as an isolated departmental tactic.
But many places are not there yet. A logical first step in the absence of a more global PFCC strategy is learning to talk directly with patients and families. Many will appreciate being given the tools to understand the information the laboratory provides and how it affects their care. It is not only an opportunity for patients, but also an opportunity for the laboratory; it’s a chance to listen to patients’ concerns and address any gaps in care. It’s also a chance to better collaborate with clinical colleagues and learn new ways to add value in an ever-changing healthcare environment. It allows pathology to become part of the patient care team. When embraced by patients and organizations alike, pathology can transform itself into an enriching and essential service that offers far more than reports and data.
There are a number of ways you can approach interactions with patients. First, make sure that you greet the patient personally and introduce yourself. If you state your specialty, explain exactly what you do, because the patient probably won’t know. In fact, they might never have come into contact with a pathologist before – so try to use simple terms to increase their understanding of pathology. Next, assess their level of medical knowledge and use understandable analogies to explain their situation. Start with an open-ended question. For instance, “What is your understanding of your diagnosis”? Asking them the first question is a sign of respect; it develops a rapport and allows you to learn what they already know so that you can start from there. Make sure you pay close attention to the words you use in your explanations; they can have an impact on the patient’s perception of their situation and their prognosis.
Always allow time for the patient to ask questions before you move from one topic to the next. Gauge the emotional landscape before you continue – after all, the information you are providing is familiar to you, but it’s brand-new to the patient and it can be quite jarring to hear. Try to answer their questions in simple terms; if you don’t know an answer, reassure the patient that you will look into it – and then make sure to follow up with them either in person or via a telephone call or message. Finally, tell the truth, and remember to show empathy for the patient. They are hearing life-changing information from you, often for the first time, so showing kindness and being prepared to handle emotional reactions gently will help you form the best possible relationship with your patients.
- KA Fleming et al., “An essential pathology package for low- and middle-income countries”, Am J Clin Pathol, 147, 15 (2017). PMID: 28158414.
- D Graves, “The impact of the pathology workforce crisis on acute health care”, Aust Health Rev, 31, S28 (2007). PMID: 17402903.
- G Isouard, “Quality of pathology services: new strategic directions required”, Int J Health Care Qual Assur, 26, 510 (2013). PMID: 24003751.
- EJ Gutmann, “‘No pictures from summer vacation’: portrayals of pathologists in the printed media”, Mod Pathol, 11, 686 (1998). PMID: 9688190.
- EJ Gutmann, “ Pathologists and patients: can we talk?”, Mod Pathol, 16, 515 (2003). PMID: 12748259.
- C Lapedis et al., “The patient-pathologist consultation program: a mixed-methods study of interest and motivations in cancer patients”, Arch Pathol Lab Med, [Epub ahead of print] (2019). PMID: 31429605.