Adding photos to path reports

[coroner]

We have a GI group that insists we add pictures of the patients’ biopsies on all path reports. Granted, it’s only one photo per report i.e. if it’s a multi-part specimen with 5 jars, we still only pick one biopsy to take a picture of. It may only take an extra fifteen to twenty seconds to snap a pic (I've timed it for the camera software to load, get the photo in focus, and resume in the report where I left off), but we get a lot of GI biopsies. Add that up over the course of a day, week, year, and it's would be a fairly significant amount of time.

I realize it can be useful once in awhile to show a clinician diagnostic cell(s), microorganisms, or tumor, but by no means is it a requirement. Let alone on every patient that crosses your desk, especially when everything is normal. I'm not a fan and I don't think any other pathologist would be either if the clinician came to them demanding pics on every report. But, I guess there’s not much my group can do. I mean, if we say, "No" to the GI docs, they will just take there business elsewhere and another practice will gleefully succumb to their demand in order to profit. It’s just a nuisance, that's all...

This probably started with some path group looking to drum up business and part of their sales pitch was telling their clinicians, "Look! Our reports come with bright and shiny color photos!" As a result, when the clinicians talk to their colleagues or go elsewhere to practice, they expect the same. I hope this doesn't become a trend if more clinicians catch on and "request" their path reports to come with photos. Anybody else required to do this?

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[KeratinPearls]

You are correct. We as a field lost the war with in office labs. In office labs are supposed to help patient care? That’s BS.

We call in our malignant diagnoses. Not much different than if we owned/have control of the pathology service

We get the same talk from clinicians. If you don’t do what we say, there’s “X nearby” pathology group willing to take the account.

In office labs just allow clinicians to exploit us.

Reminds me of the proverb: "Absolute power corrupts absolutely" means that when a person has power over others (or things) it has a tendency to corrupt them.

We provide a service. Like all businesses if you don’t provide the service, you will lose the customer.

 

[cmz]

I am waiting for the QR code clinicians can scan on a path report coupled with a proprietary holographic image viewer. Imagine a Star Wars-esque 3D holographic video pops up with the pathologist's face/upper torso near a microscope explaining the cancer diagnosis in detail with swirling animations of DNA, high res glossy photos of the patient's tumor, etc. Maybe 4D it with a spritz of formalin after the holographic video ends?

 

[deleted314957]

We have a GI group that insists we add pictures of the patients’ biopsies on all path reports. Granted, it’s only one photo per report i.e. if it’s a multi-part specimen with 5 jars, we still only pick one biopsy to take a picture of. It may only take an extra fifteen to twenty seconds to snap a pic (I've timed it for the camera software to load, get the photo in focus, and resume in the report where I left off), but we get a lot of GI biopsies. Add that up over the course of a day, week, year, and it's would be a fairly significant amount of time.

I realize it can be useful once in awhile to show a clinician diagnostic cell(s), microorganisms, or tumor, but by no means is it a requirement. Let alone on every patient that crosses your desk, especially when everything is normal. I'm not a fan and I don't think any other pathologist would be either if the clinician came to them demanding pics on every report. But, I guess there’s not much my group can do. I mean, if we say, "No" to the GI docs, they will just take there business elsewhere and another practice will gleefully succumb to their demand in order to profit. It’s just a nuisance, that's all...

This probably started with some path group looking to drum up business and part of their sales pitch was telling their clinicians, "Look! Our reports come with bright and shiny color photos!" As a result, when the clinicians talk to their colleagues or go elsewhere to practice, they expect the same. I hope this doesn't become a trend if more clinicians catch on and "request" their path reports to come with photos. Anybody else required to do this?

We had to start doing this 10 years ago before I retired.

 

[Spikebd]

You are correct. We as a field lost the war with in office labs. In office labs are supposed to help patient care? That’s BS.

We call in our malignant diagnoses. Not much different than if we owned/have control of the pathology service

We get the same talk from clinicians. If you don’t do what we say, there’s “X nearby” pathology group willing to take the account.

In office labs just allow clinicians to exploit us.

Reminds me of the proverb: "Absolute power corrupts absolutely" means that when a person has power over others (or things) it has a tendency to corrupt them.

We provide a service. Like all businesses if you don’t provide the service, you will lose the customer.

Do you really own that bored ape? I love it. Pathologists gmi

 

[WEBB PINKERTON]

GYN and GI docs have asked us to do this but we told them to pound sand.

 

[coroner]

GYN and GI docs have asked us to do this but we told them to pound sand.

And if they threaten to take their business to another pathology group that will, and you lose 40% of your revenue, then what? The only way that works is if you're prepared/don't care to lose their business.

There's only two scenarios I could see where this can be pulled this off successfully: 1) You are employed by the hospital and don't care about the lost volume because your paycheck stays the same. 2) The GI & GYNs contract with the hospital requires them to send all specimens to your lab. This is unlikely if their group is private; because, these specimens often originate from OP offices and the GI/GYN practices wouldn't sign such a contract restricting them to a single lab.

 

[WEBB PINKERTON]

The docs practices are owned by the hospitals so good luck if they want to send them somewhere else. The high table of the health system will come set them straight mighty quick.

It is a waste of time and money to be putting images on reports. Serves no purpose.

 

[coroner]

The docs practices are owned by the hospitals so good luck if they want to send them somewhere else. The high table of the health system will come set them straight mighty quick.

Makes sense: Scenario #2 in my example...

 

[WEBB PINKERTON]

Sounds like some of us are wasting enough time with this early release BS.

Account Suspended

 

[deleted314957]

The docs practices are owned by the hospitals so good luck if they want to send them somewhere else. The high table of the health system will come set them straight mighty quick.

It is a waste of time and money to be putting images on reports. Serves no purpose.

In this situation, I would have too. Unfortunately, I was working before everyone got bought up and we WOULD have accounts walk if we did not image reports.

 

[WEBB PINKERTON]

Would these same GI docs expect images on their reports from their broom closet residing pathologist if they had an in-office lab?

More time doing this crap, is less time at the scope. More chances for errors.

 

[deleted314957]

Would these same GI docs expect images on their reports from their broom closet residing pathologist if they had an in-office lab?

More time doing this crap, is less time at the scope. More chances for errors.

I agree completely. You could take a photo of a placenta. Having been in general practice, i know how this goes. They take the report and show the pretty picture to the patient who “ oohs and aahs” . Many of the patients actually think this is the work product of their surgeon, gi, uro, etc. The concept of a pathologist is not mentioned or just brushed over. After all, the vast majority of patients think pathology=autopsy.
It is indeed a waste. Sadly, some folks have to do it or be gone.

 

[Guest8]

I agree, there's no clinical or patient benefit to us putting a picture on a path report. But, if some lab is doing it and it looks shiny and new, some will demand it. I had a plastic surgeon say they wanted to send us their skins, but the lab they currently used had pics on the reports and if we couldn't do that then they wouldn't switch. So, they didn't switch. Ah well.

And yes, as soon as these types of labs hire someone in house they give up all their prior outrageous demands. Derms all demand like 24 hr sign out on their cases. Well, until they hire an in-office dermpath to read them, then even if they dermpath only comes to read once a week they're fine. Then all of a sudden those rush diagnoses aren't so "rush" anymore, as long as the money's rolling in.

 

[WEBB PINKERTON]

Yea, they love to spend your money and force you to appease them but suddenly they don't care about images if THEY need to make the investments. We don't even try to do business with derms any more. Most of them are selling out to VC and the specimens funnel into the VC lab so it is a lost cause. I wonder if the VC labs do images?

 

[Med Director New England]

In my residency all of the tedious picture-taking for tumor Boards, multidisciplinary conferences & discussion of the cases trickled down to the residents.

We used to gripe about this and bemoan the fact that the folks we were presenting too had no idea anyways.

Remember one of my chief residents offering sage advice - always keep a photo at 400x with a clusters of eosinophils for any pathologic process that involved them.

They were always crowd pleasers and got a few oohs and aahs- in this setting.

You could just keep a stash of the common entities TA, TVA, HP, and SSAP, active colitis
, micro colitis and just dump them in with a disclaimer that the images are for illustrative purposes only not for diagnosis.

 

[deleted314957]

Only if there were just fewer of us. Another 3.7% cut. We are truly one of the few specialties where no other specialty thinks they can even ATTEMPT to do our job. Sure, a derm can look at skin, PERIOD. NO surgeon, gi, gu, gyn, uro will BOTTOM LINE a path report. ( granted there are very rare exceptions). How in the world did we screw up so badly. I was just figuring it out and $700K in 1992 is equivalent to 1.3+ M today. That was good, but not unusual PP compensation then. How the worm has turned.

 

[LADoc00]

Going out to get new anatomic business is such a waste of time and money, you could crush returns just day trading the inertia in crypto with the time instead.

Almost no OP or hospital based AP biz model makes sense anymore when you can just remotely direct CP operations and reap passive income.

 

[DrTeddy]

It's frustrating to see what should be an awesome specialty suck. We are insulated from competition with physician extenders by virtue of what we do, an advantage most specialties don't have. The problem is we train too many pathologists, and the specialty will suck until that stops. I have talked to people considering pathology and I almost universally tell them not to, which doesn't feel good, but I'm not sure what else to do. The CAP is essentially useless in advocating for regular community pathologists. I know some who would disagree with that, but looking at the number of US graduates entering the field, rise of POL, etc., it seems to me there is no debate.

 

[KeratinPearls]

It's frustrating to see what should be an awesome specialty suck. We are insulated from competition with physician extenders by virtue of what we do, an advantage most specialties don't have. The problem is we train too many pathologists, and the specialty will suck until that stops. I have talked to people considering pathology and I almost universally tell them not to, which doesn't feel good, but I'm not sure what else to do. The CAP is essentially useless in advocating for regular community pathologists. I know some who would disagree with that, but looking at the number of US graduates entering the field, rise of POL, etc., it seems to me there is no debate.

Pathology programs are matching applicants who use Path as a backup because they couldn’t match into Family Medicine. Let that sink in.

 

[deleted314957]

Even my path report on radical robotic prostatectomy was effed up by supposed “ experts” ( read: fellow at prestigious name who never had to bottom line a report herself) by not recognizing the difference in invasion of INTRAPROSTATIC seminal vesicle vs TRUE seminal vesicular invasion defined as NOT intraprostatic component. BIG difference in staging and prognosis. No surprise, I have done much better than folks with stage 3 dz who have true seminal vesicle invasion.
Never ever having had ANY independent responsibility either as a clinician or as a pathologist have left the field with a bunch of naïfs. ALWAYS check any path reports on you and your loved ones.

 

[Allegri]

I would argue the failure to distinguish intraprostatic SV/ejaculatory duct vs. true seminal vesicle is a deficiency in being taught that distinction or not reading, rather than never having the experience of signing out cases. That fellow will now go on to incorrectly diagnose numerous prostatectomies with full confidence they are doing it correctly because of the big name they trained at.

 

[deleted314957]

I would argue the failure to distinguish intraprostatic SV/ejaculatory duct vs. true seminal vesicle is a deficiency in being taught that distinction or not reading, rather than never having the experience of signing out cases. That fellow will now go on to incorrectly diagnose numerous prostatectomies with full confidence they are doing it correctly because of the big name they trained at.

And everyone will take that report at face value.

 

[Nilf]

And everyone will take that report at face value

Mike, thank you for sharing your story. You've implied a while ago that your retirement saved or prolonged your life because it led to a timely detection of your cancer. Do you mind elaborating on that? Did you simply have more time to get check ups? Did your busy lifestyle while employed mask the symptoms?

 

[deleted314957]

Mike, thank you for sharing your story. You've implied a while ago that your retirement saved or prolonged your life because it led to a timely detection of your cancer. Do you mind elaborating on that? Did you simply have more time to get check ups? Did your busy lifestyle while employed mask the symptoms?

I had the time to really see a doctor rather than engaging in curb side consults in the hall and a very small 1.5 cm gleason 4+4 was discovered. Thankfully i have done about as good as you can do. But you do become a professional patient for a couple few years. I was asymptomatic of course.