Power to the Pathologists

How did your journey into pathology begin?

I studied preclinical medicine at Cambridge University and did the clinical aspects of the course at the London Hospital. Subsequently, I did general medical and surgical jobs, then worked in accident and emergency, and subsequently medicine for the elderly at Guy’s and St. Thomas’ NHS Foundation Trust. I think a memorable moment that helped solidify my path involved Professor Sir Colin Berry, who was then head of the pathology department at the London Hospital. He introduced the department by saying that they had produced approximately 30 Professors of Pathology and he expected me to follow suit. At the time (and at that stage of my career), I was inspired by the fact that someone would encourage me not to limit my expectations!

What key moments prepared you to be President of the Royal College of Pathologists?

In terms of skills and experience, I think the broad scope of my career helped. I did the general Part 1 exam, covering the basics of all pathology disciplines. I became a histopathologist and a professor of neuropathology – although I was a general pathologist, my PhD was in neuropathology; I’ve been head of pathology and learnt lots about all the various areas; head of a clinical support division; and I was clinical advisor to Ian Barnes during the Barnes review period, which introduced me to the national side of medicine. And although you clearly need to bring skills and expertise to the role, I also think you need to bring a lot of who you are as a person. My drive has always been to make things better – or at least to try! I want to have a positive impact wherever I go, by leaving things in a better state than I found them.

What do you hope to achieve as President?

I have a two-pronged approach: I want patients to have really good pathology services, and I want pathologists to feel better about themselves and their profession. Everyone is under a great deal of pressure at the moment, so anything we can do to make their lives better is really important.

I want patients and the general public to know just what an astonishing level of expertise they have supporting them through their screening, disease prevention, diagnosis, and treatment. I don’t think the public are entirely aware of the kinds of experts who support them behind the scenes. To encourage better understanding, the College has been doing a lot of public engagement with charities and schools to help raise the profile of pathologists in the public’s mind. We’ve got phenomenally clever individuals in every department who have trained for 12 or more years, and they deserve recognition.

It’s also something we want to tell the next generation of medical students. To that end, we’ve got some exciting programs to support the medical school curriculum with pathology resources. We want to ensure that the path to our specialty has a higher profile and we need medical students to be fully aware of the impact they could have as pathologists.

What is currently the most exciting area of pathology?

There’s massively exciting stuff going on all over the field – computational pathology, gene therapies, interconnectivity – so it’s difficult to pick just one. That said, an area that sticks out to me at the moment is the prospect of scanning mass spectrometry combined with morphology and data from the 100,000 Genomes Project. Such a combination of technology gives a complete morphological, genetic, and protein map of tissues, and it’s coming down the line very fast. All medicine is personalized, of course, but giving doctors the potential to make decisions based on personal data on a patient’s genome, metabolome, epigenetic status, and biochemical condition is very exciting.

If you could change one thing about the field, what would it be?

I think I would double the workforce. We can buy things like new equipment – which is undoubtedly needed – but the enormous strength and capability behind pathology lies in the brains and skills of the people. They want to do what’s best for the patient, and because they serve all areas of healthcare, across all settings, they know how things work and how things could be better. With a little more leeway, they can bring new tests and therapies into play faster, but could also use their experience, as well as analytical and innovative approaches to improve the whole patient pathway.

Pathologists are more than capable of making massive changes to our profession. On many occasions pathology has undergone total transformations that people haven’t really been aware of – adopting liquid-based cytology, molecular transformations in microbiology, virology, and genetics. When new technology is brought in, we retrain every single member of the workforce, all of whom adapt to it seamlessly. There aren’t many fields where that holds true! I think, above all else, the people behind pathology are the most valuable assets in the discipline. Given a little bit of time, pathologists are capable of astonishing things.