---

Gynecologic Pathology Fellow, Department of Pathology, Michigan Medicine, University of Michigan, USA

Controversial opinion? Through my work in Peru and Rwanda, I have reflected on how technologically advanced and resource-rich we are in the United States. When you visit countries with only one pathologist per 1 million people and lacking the infrastructure to process tissue effectively, you come to appreciate the resources available to create ideal specimens for pathology review. 

In these contexts, obtaining the latest molecular or IHC stains is not the immediate solution. Instead, in under-resourced countries we should focus on teaching and producing the highest quality H&E slides. Although there is a great need for telepathology, its global value is limited unless we address the variability in staining protocols that arise in underserved areas. This variability drastically affects the quality of scanned images.

Moreover, many of the ancillary tests we use for cancer biomarkers depend on tissue being processed with minimal ischemic time, typically beginning formalin fixation in cassettes within 24 hours of collection. But how can a lab effectively run breast biomarkers on a specimen that has been in formalin for three months without any preparation to ensure proper formalin penetration into the cancer tissue? 

While I understand the allure of new technology and its potential to improve hospital operations, I firmly believe that good specimen preparation and timely diagnosis will have a more sustainable impact on patient care. These priorities will lead to better treatment outcomes and enhance the overall quality of life for patients worldwide, making them crucial aspects of healthcare.

Book recommendation? "Being Mortal" by Atul Gawande explores a surgeon’s journey through end-of-life care with his patients and his father. Gawande discusses how the US medical system focuses on curing disease and prolonging life, raising important questions about the cost of this ideology. What is the impact on the patient? And on the healthcare system? When should we consider prioritizing quality of life over quantity of years?

The end of life forces us to ask hard questions about what we value. But we do not have to wait until then to reflect on these issues. Throughout my medical training, the pursuit of knowledge and skills to improve people's lives has been all-consuming. Yet, I frequently found myself so engulfed in my career that I overlooked the quality things that make life meaningful. No matter how much we, as scientists, strive to achieve our dreams and make medical advancements, we must always remind ourselves of our humanity and how we can nurture the values that make life worth living.

Attracting talent… We must embrace an approach that engages talented scientists at multiple stages of their journey. Reflect on the interactions that inspired you to choose medicine. Imagine placing pathologists in those transformative situations. For me, these were conversations with my primary care provider as a child and meeting a medical student who volunteered at the medical examiner’s office. 

We need to be a contact point for questions and a bridge to experiences that can ignite a student's career. Connecting students – whether in high school, undergrad, or medical school – with working pathologists is monumental. This is our opportunity to actively demonstrate the real-world relevance of the knowledge they acquire in school.

Within clerkships, interactions with residents, fellows, and attendings become crucial. Be an active, engaged teacher. When working with students, focus not just on getting the job done but also on encouraging exploration and inquisitiveness. These seemingly small interactions have colossal impacts.

Remember, it's not just about showcasing the pathology specialty; it’s about fostering an environment where people feel inspired and supported. Spread the word, be accessible, and make this pathology journey open to everyone.