A message to the budding pathologist

[CornellDerm]

---

Members don't see this ad.

As a PGY-4, I have been recently looking back on the last four years or so of training and contemplating my initiation, if you will, into the world of pathology. The hardest part at first will probably be explaining to everyone at your med school graduation party and everyone else in your life what a pathologist is. Everyone will assume that you are embarking on a journey into the underworld doing autopsies. They will be baffled why you wouldn't rather do plastic surgery. This will be even worse if your family belongs to a country club or you are graduating at the top of your class, because your mother's friendly Botoxophiles and even your ignorant medical school colleagues will lack insight and tell you that you are wasting your precious step scores and AOA membership.
Several years later, these same people with a newfound understanding of your career choice will be sending you (no probably FedExing), anxiously, their own breast core biopsies, reading you their own child's brain tumor pathology report, or asking you to explain what on earth is LSIL or a LEEP procedure or the difference between a Pap and a biopsy.
The point here, is that only those (un)fortunate people who find themselves "waiting by the fax machine" (as one great pathologist once told me) will ever truly respect your decision to become a pathologist. I bumped into my good friend and trauma surgery partner during 3rd year of med school yesterday and he said, "remember when we finished the rotation and you said you would never have to sleep in a call room again"? Did that end up being true? I said, "yes, come to think of it, I never have slept at the hospital again....no more pillow hair during morning report, etc. etc." He is in his 4th year of surgery residency and was obviously jealous! I write all this because I myself was very pensive and doubtful at first about my decision. People will get to you even if they are idiots. Just stay focused and ignore them. Do you agree SR?

 

[veo1]

As a newly minted PGY-1, thanks for this post! You've described my M3-M4 years to a tee. I always felt like I was making the right decision but its so hard when noone (and even a lot of ppl in medicine) really knows or seems to care about what pathologists do. I went to church last weekend and tried to explain it to a group of people that asked about my work, only to have one guy respond "so, you're a tech?!" *sigh* 😎 I don't even think my mom really understands what I do. Oh well, you can't have it all. I knew good and well it would be like this before I matched. I'd love to hear more inspirational tidbits if anyone has them to share! I could really use a boost, as I began this year on 3 straight months of CP 😉

 

[CornellDerm]

Glad I could shed some light on the big picture. I just remember how many hours, in my younger years, that I wasted doubting my decision to pursue pathology. Those hours could have been better spent, no doubt.
I realize now that many very brilliant people attracted to medicine choose pathology for a career. Often these people (I have observed) also have a passion for the humanities and/or arts. Indeed, I myself studied both biology and literature in college. Generally speaking, I haven't yet decided whether these gifted people have chosen pathology so that they would have time to pursue their other artistic loves or whether peering down the microscope every day is equally gratifying to their artistic appetites. I suppose it is a bit of both. That being said, these Renaissance pathologists to whom I am referring most certainly don't care about entertaining the ignorant populace. Best of luck!

 

[b&ierstiefel]

Glad I could shed some light on the big picture. I just remember how many hours, in my younger years, that I wasted doubting my decision to pursue pathology. Those hours could have been better spent, no doubt.
I realize now that many very brilliant people attracted to medicine choose pathology for a career. Often these people (I have observed) also have a passion for the humanities and/or arts. Indeed, I myself studied both biology and literature in college. Generally speaking, I haven't yet decided whether these gifted people have chosen pathology so that they would have time to pursue their other artistic loves or whether peering down the microscope every day is equally gratifying to their artistic appetites. I suppose it is a bit of both. That being said, these Renaissance pathologists to whom I am referring most certainly don't care about entertaining the ignorant populace. Best of luck!

Thanks for the post. I felt the same way you did and initially I may have entered pathology for the wrong reasons. Now after 2 years of residency and as a fellow, I appreciate you thoughts...I couldn't agree with you more!

 

[pathstudent]

I don't think clinicians ever come to respect or appreciate pathologists. I think they just find us annoying. I remember one time we were taking many days doing battert after battery of immuno stains for purely academic reasons, and the surgeon called me and asked what was taking so long and I said we were doing immunos for "blah blah blah" and he said "i don't give a **** about any of that. Are the lymph nodes positive or negative?" That moment made me realize that our only relevance is if we are relevaNT to the surgeons and clinicians. we exist to serve surgeons and clinicians. they are the real doctors with real patients, while we just have specimens and cases,

And clinicians definitely know the difference between a PAP and biopsy.

I think they view pathology as like the clin lab, like a biopsy report is basically like a CBC.

 

[Neddy]

I don't think clinicians ever come to respect or appreciate pathologists. I think they just find us annoying. I remember one time we were taking many days doing battert after battery of immuno stains for purely academic reasons, and the surgeon called me and asked what was taking so long and I said we were doing immunos for "blah blah blah" and he said "i don't give a **** about any of that. Are the lymph nodes positive or negative?" That moment made me realize that our only relevance is if we are relevaNT to the surgeons and clinicians. we exist to serve surgeons and clinicians. they are the real doctors with real patients, while we just have specimens and cases,

I wouldn't expect anyone to respect or appreciate a pathologist who delays signing out a case for "many days" to do immunos "for purely academic reasons." Pathologists who provide critical diagnostic information in a timely manner are "real doctors" and in my experience are respected accordingly. We exist to serve PATIENTS, although our position is such that we can only do so by working with other doctors (which can be said for plenty of other specialties as well.)

 

[b&ierstiefel]

I wouldn't expect anyone to respect or appreciate a pathologist who delays signing out a case for "many days" to do immunos "for purely academic reasons." Pathologists who provide critical diagnostic information in a timely manner are "real doctors" and in my experience are respected accordingly. We exist to serve PATIENTS, although our position is such that we can only do so by working with other doctors (which can be said for plenty of other specialties as well.)

Yup. And that's what entering preliminary diagnoses are for! And especially if the additional immunos are not crucial for the diagnosis, why not just report the additional immunos as an addendum?

That being said...every specialty tends to be detail oriented in different ways. Pathology certainly can get bogged down in classification schemes...for example, diagnosis A vs. B vs. C but at the end of the day, all three entities get treated the same. But we'll perform rounds and rounds of impox. To an extent, this "academic" exercise can be important because if we can't properly classify disease entities (based on current understanding), we can't understand them later when more sophisticated techniques provide additional information which may prove relevant in the future. Whatever.

At least we don't have to care about inputs and outputs and loading up patients with lasix the night before so that the I's and O's look good for the next morning's rounds. Whatever.

One other thing...I certainly do feel that there are clinicians out there that see pathology as a black box. Too bad...that's what we have to deal with. But at least we don't have to adjust metformin doses based on blood sugar diaries and convince people to quit smoking. Whatever...

Input --> {pathology} --> get answer you want --> clinician treats patient --> everybody happy --> yay!

Oh wait...but sometimes all you get is a differential instead of an exact answer? And maybe you even get that "clinical correlation is needed" note (i.e., go back to the drawing board).

Oh no! System overload!

Whatever.

 

[yaah]

I always just keep in mind a few simple truths

1) Many people in this world are full of ****
2) Too many people only see things that are directly in front of them
3) Many people only give respect to those who can get them more money or prestige.
4) These people in the above three categories are usually not people whose opinions should matter to you. They may be your supervisors or people you have to deal with, but that doesn't necessarily mean their opinion is correct.

When people badmouthed pathology or questioned my choice of career, I usually just looked at the whole circumstance of the comment. Sometimes it was an ignorant person, sometimes it was a person who thinks their field is the only one that matters. Occasionally it is a smart person who you respect, but often they are only saying it because they want more people like you in their field (i.e. it's a compliment).

If you don't do what you like doing, your life is going to be a lot tougher. I could have done radiology or derm, but I wouldn't have been happy. Not everything should be about money, prestige, or trying to impress people whose opinions don't matter.

 

[CameronFrye]

I don't think clinicians ever come to respect or appreciate pathologists. I think they just find us annoying. I remember one time we were taking many days doing battert after battery of immuno stains for purely academic reasons, and the surgeon called me and asked what was taking so long and I said we were doing immunos for "blah blah blah" and he said "i don't give a **** about any of that. Are the lymph nodes positive or negative?" That moment made me realize that our only relevance is if we are relevaNT to the surgeons and clinicians. we exist to serve surgeons and clinicians. they are the real doctors with real patients, while we just have specimens and cases,

And clinicians definitely know the difference between a PAP and biopsy.

I think they view pathology as like the clin lab, like a biopsy report is basically like a CBC.

I have almost never seen the behavior/attitudes described in this post. In fact, some of my most rewarding experiences in pathology have been the interactions with clinicians. I have been at multiple tumor boards where the pathologists and clinicians have had a long discussion about a patient, and the treatment was modified based on those conversations.

Also, I agree that the Final Report should've been issued and then an addendum could've been issued detailing the immunos. However, if the immunos truly were just academic, then I wouldn't have issued an addendum (to prevent the patient from being billed extra).

 

[mlw03]

I wouldn't expect anyone to respect or appreciate a pathologist who delays signing out a case for "many days" to do immunos "for purely academic reasons." Pathologists who provide critical diagnostic information in a timely manner are "real doctors" and in my experience are respected accordingly. We exist to serve PATIENTS, although our position is such that we can only do so by working with other doctors (which can be said for plenty of other specialties as well.)

i would agree with this. if a patient has positive nodes, that changes staging, and thus treatment. clinicians want to know ASAP what the stage is so they can start the right treatment, and pathologists should do what they can to get the right answer to the clinicans quickly. i also would say that aside from just a few putz surgeons, most all clinicians i've dealt with treat pathologists with the same respect they would any colleague.

in any case, thanks CornellDerm, for a very nice post.

 

[Psychopathology]

Path is incredibly challenging, or at least it felt that way when I took on PGY1 responsibilities. It was also clear to me how pathology was important to patient care. At tumor board, a respected senior surgeon had just finished offering his opinion of a tumor he had resected, when he turned to me and asked, "So, what was the pathology?" I realized that the information I had reviewed over and over again with my attending and was about to convey could dictate the course of his patient's therapy. That's a lot of responsibility. There's a reason it takes an MD with four to six years of additional training to enter the field, and hopefully to do the work well.


It's absurd to imagine that someone could "waste" their talents on this field. It deserves just as many intelligent minds as any other. The truth is that pathology is not an extremely competitive match right now and the medical student mentality is to compete for the biggest and brightest accolades, sometimes at the expense of understanding and happiness. Path is also hard work, it's messy work, it takes a while to pick up, you don't receive as many free meals, there are lots of misconceptions floating around about what a pathologist actually does, and most importantly, there are no television dramas about the lives of pathologists. It's kinda mysterious and not too tough to get into, so some med students ignore it.


But it can also be a hidden gem. If it makes you happy to get out of bed in the morning, then it's probably a good match for you... at least, that's just how I look at it. Your job is what you'll spend most of your time doing. Better enjoy it.

 

[TheCritic]

Path is incredibly challenging, or at least it felt that way when I took on PGY1 responsibilities. It was also clear to me how pathology was important to patient care. At tumor board, a respected senior surgeon had just finished offering his opinion of a tumor he had resected, when he turned to me and asked, "So, what was the pathology?" I realized that the information I had reviewed over and over again with my attending and was about to convey could dictate the course of his patient's therapy. That's a lot of responsibility. There's a reason it takes an MD with four to six years of additional training to enter the field, and hopefully to do the work well.


It's absurd to imagine that someone could "waste" their talents on this field. It deserves just as many intelligent minds as any other. The truth is that pathology is not an extremely competitive match right now and the medical student mentality is to compete for the biggest and brightest accolades, sometimes at the expense of understanding and happiness. Path is also hard work, it's messy work, it takes a while to pick up, you don't receive as many free meals, there are lots of misconceptions floating around about what a pathologist actually does, and most importantly, there are no television dramas about the lives of pathologists. It's kinda mysterious and not too tough to get into, so some med students ignore it.


But it can also be a hidden gem. If it makes you happy to get out of bed in the morning, then it's probably a good match for you... at least, that's just how I look at it. Your job is what you'll spend most of your time doing. Better enjoy it.

Damn skrate!