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Consultant in Endocrine Pathology, University Hospitals Cleveland Medical Center, USA, and University Health Network, Toronto, Canada; Professor, Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA

Biggest challenge in pathology? The invisibility of pathologists to patients and the public is a major challenge for the field. Most patients do not understand what we do and how we do it; they think of pathology as a black box into which one drops a specimen and out comes an answer. Pathologists must make a concerted effort to become consultants who meet with patients to provide them with the information from our testing, explain to them the implications of the results, and offer guidance on next steps in their healthcare journey. In the same vein, Pathologists must do a better job of communicating with the public to be recognized as the gatekeepers of authentic scientific information about health and disease.

Missing from the diagnostic toolbox? Pathologists are not well prepared to convey their knowledge, wisdom, and guidance to patients. Our toolbox currently does not include what is required to meet with a patient, provide them with the information we have about their situation, convey compassion, and offer guidance for navigating their treatment journey.

Controversial opinion? I am a firm believer in subspecialization of pathology. As information grows exponentially, no one can know everything about every area of pathology; for this reason I support pathology training across all areas to build a strong foundation in the field and to develop an understanding of laboratory management, however it is critical that we move away from general practice and instead develop clinicians with expertise in specific diseases. In the era of AI, the generalist will be replaced by a computer. However, while AI can handle information, it lacks knowledge, understanding, and wisdom. 

Pathologists who work in a subspecialty environment as integral members of a multidisciplinary care team are the bridge between science and clinical care, the people with knowledge about the cell lines and animal models of the diseases that they diagnose; they are familiar with the subtle features of clinical presentation, the biochemical and radiologic features, and treatment options for each disease entity. They should be able to provide patients and their treating physicians and surgeons with advice on how to manage every case.