The Visual Pathologist

You’ve broken new ground in soft tissue pathology, being the first to describe and characterize a number of soft tissue pathologic entities – what drew you to the field?

Two things. First, my father was a surgeon, and spoke very highly of pathology, and the close relationship between surgical pathologists and surgeons. Second, I’m a visual person, and pathology is an intrinsically visual area. So much of the work is based on recognizing patterns, and matching them with disease entities, which is something that really appealed to me.

What was it like to be the first female chief resident in pathology at Johns Hopkins University?

It was an honor to be picked as chief resident, but honestly, I didn’t feel very different. I was treated well, and I never felt singled out or held up on a pedestal, I was just doing my job. Johns Hopkins was very much at the forefront of women in medicine – they’ve really fostered the careers of women, although we didn’t have many women rising to the top ranks; it was unusual for a women to be a full professor.

What are your career highlights?

Well the first one has to be graduating from medical school! Publishing the book Soft Tissue Tumors, which I co-authored, was another one. Back in 1982 it was the first real reference book in that area, and it was very well received.

Other highlights are more recent. As I became more senior in my field, I served as President of the American Board of Pathology (ABP), and also as President of the United States and Canadian Academy of Pathology (USCAP), which was great as it put me in a position to change the field for the better. One of the major initiatives I have been involved in is creating the Maintenance of Certification examination for recertification, including picking which topics we should test and how we should test them.

How important is mentorship?

I think it’s critical. In my career I’ve had two main mentors – firstly my father, and also Franz Enzinger with whom I wrote Soft Tissue Tumors. Having a strong mentor gives you an advantage; they can not only teach you how to be a pathologist, but help you to navigate the academic waters in other ways. And I wanted to pass on these advantages.

In my career I’ve trained many residents and over 25 fellows in bone and soft tissue, and many of them are now doing incredibly well on their own at major institutions. It has been such a rewarding experience.

What are the biggest challenges facing pathology?

We need to give pathologists more time to be creative – it’s such a big specialty, with a lot to learn. But we can’t just teach students how to read slides, they need more space to do research and find ways to advance the field, not just practice in it. And that’s going to come from our young faculty.

But that brings us to our other problem – there’s a pipeline issue. Pathology isn’t well known to the public, and we don’t have a major presence in medical school curricula any longer. This means we’re not attracting large numbers of the best and the brightest.

Of course, there are the problems facing medicine in general: reduced reimbursements for what we do, and increasingly being forced to do much more with less…

How can pathology be made more appealing?

We need to have a better presence: pathologists need to be involved when multidisciplinary courses are taught, we need to be part of the teaching teams.

Along with this, we need to offer students dedicated experiences. For example, here at Emory we have a post-sophomore fellowship that allows medical students to spend a year in pathology as if they were an intern. Unsurprisingly, it’s very rare that someone who takes the fellowship doesn’t end up hooked. And why wouldn’t they be? Unlike many specialties, pathology cuts across every field. You see material from children and adults, you see chronic disease, acute disease, and tumors of all types. It’s such a diverse field, and when students realize that, they see the draw.

What’s exciting you right now in pathology?

Pathology has always excited me. The opportunities to consult in interesting and difficult cases, and to make the right diagnoses and help my patients, continues to engage me, which is great.

Looking forward, we are on the brink of – or perhaps it’s better to say we’ve now arrived at – a molecular revolution. It’s now possible to characterize disease in a very molecular and mechanistic way, and these have the potential to translate into refined, targeted therapies. Although I’m not doing molecular research myself, I see these advances being applied to my cases, and that’s very exciting.