The Transformed Pathologist

The “transformation” of pathology has increasingly become a buzzword in the field’s literature over the last five years. Transformation suggestions run the gamut from pathologists’ embracing precision medicine to their participation in diagnostic management teams (see “Curing Our Diagnostic Disorder,”). All of these suggestions have merit in the quest to further emphasize the value of being a pathologist – both in the view of others (such as our colleagues, medical students, administrators, regulators, and payers) and for ourselves.

Yo Yo Ma, when he was seven years old, performed before the great cellist Pablo Casals. Casals was impressed with the young prodigy, but nevertheless told him: “You should also play baseball.” In other words, stretch your interests and limits, regardless of your age. Casals also told Ma that he was a human being first, a musician second, and a cellist third – specifically in that order. In my opinion, a transformed pathologist should be a human being first, a physician second, and a pathologist third – again, specifically in that order.

Why? My view of pathologists as physicians first involves face-to-face interaction with patients regarding their medical care. Historically, many famous physicians worldwide were pathologists first, then further trained to be surgeons, internists and pediatricians. Clinicians through the ages have gone back into training, completing pathology residencies to augment their understanding of the concepts of disease (1) – knowledge that is useful both in the research laboratory and at the patient’s bedside.

Healthcare professionals talk about the absolute necessity for clinical-pathological-radiological correlation to increase the likelihood of correctly diagnosing the “problems” affecting patients, especially in regard to skin disorders, bone tumors and chest nodules. How better to be of value than to be very clinically oriented – if not clinically trained – in these subspecialties of medicine?

Instead of merely “talking the talk,” I have borrowed two concepts from other healthcare professional groups to actually “walk the walk.” First, I have set up a melanoma clinic in the underserved region of western Nebraska, where skin cancers (including melanoma) are often diagnosed at later stages. And second, I have set up an interventional pathologist practice where I personally perform bone marrow aspirations, fine needle aspirations, shave and punch biopsies, and more. In that practice, I personally perform the procedures (bone marrow aspirations and biopsies, skin biopsies, soft tissue fine needle biopsies, and so on), then immediately examine the material to either provide a quick diagnosis or repeat the biopsy immediately if the sample is inadequate.

Are you, like me, a pathologist who enjoys interacting with patients? Do you, like me, believe that wholesome patient interactions primarily improve patient care and outcomes, and secondarily improve your status as a valued member of the healthcare team? If so, then I encourage you to transform yourself into a clinician-pathologist. Remember, the word “art” occurs four times in the Hippocratic Oath. Expand your practice of the “art of medicine.” Yes, transforming into a clinician-pathologist will feel awkward for a few weeks – but once that passes, you will gain credibility and confidence, as well as the respect and admiration of others – including me.