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Can you learn to enjoy grossing?

pathanon

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Jun 30, 2020
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Hello everyone,

I've searched the forum but I haven't found anything similar answering my question so I went ahead and made this thread.

So after extensive research and soul searhing I've reached the conclusion that pathology is the only specialty which suits me(maybe rads a very distant second).The positives are numerous i.e intellectually stimulating,no patient contact,I'm way more into the science than practising medicine,no social medicine bs,hated anything after pre-clinical years etc

I scheduled a shadowing week to figure out what I would be getting myself into before commiting.What I've gathered is that I thoroughly enjoy spending time at the microscope but I can't say the same about grossing;I felt very disconnected and a bit grossed out e.g cutting through mastectomies made me feel uneasy.I understand that no job is perfect but I'm trying to figure out how big of a part grossing is in the daily grind.

Does anyone else relate to what I'm describing?Did you initially disliked grossing but then you started enjoying it?Is it possible to become a good pathologist if you don't have a thing for cutting specimens?

Thank you everyone who took the time to read my post and maybe share your opinion!
 

KeratinPearls

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If you go into academics you won’t have to gross. In private you may have to gross based on the job setting and whether there is a PA available or not (the PA is on vacation so members of the group have to gross).

I don’t mind grossing. I never disliked it. It’s an important part of a pathologists job to know about your patients specimen and appropriate sections to take.
 
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ScubaV

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There's a balancing act when it comes to grossing and other areas of pathology. On one hand, you need to mentally distance yourself to keep an objective mind and not get consumed by all the cancer we see every day, especially in young and tragic cases. For example in a mastectomy, in the act of grossing don't think of it as a woman's breast, think of it as a puzzle that you need to solve to prepare the best slides possible to make the most accurate diagnosis.

Generally this isn't too hard as repeated exposure to anything tends to make you desensitized. The other part of the balancing act is to remember that these are real people and not just accession numbers. What you do and say makes a big difference, whether at the grossing station or the microscope.
 
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CDX-2

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Dec 15, 2018
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Hello everyone,

I've searched the forum but I haven't found anything similar answering my question so I went ahead and made this thread.

So after extensive research and soul searhing I've reached the conclusion that pathology is the only specialty which suits me(maybe rads a very distant second).The positives are numerous i.e intellectually stimulating,no patient contact,I'm way more into the science than practising medicine,no social medicine bs,hated anything after pre-clinical years etc

I scheduled a shadowing week to figure out what I would be getting myself into before commiting.What I've gathered is that I thoroughly enjoy spending time at the microscope but I can't say the same about grossing;I felt very disconnected and a bit grossed out e.g cutting through mastectomies made me feel uneasy.I understand that no job is perfect but I'm trying to figure out how big of a part grossing is in the daily grind.

Does anyone else relate to what I'm describing?Did you initially disliked grossing but then you started enjoying it?Is it possible to become a good pathologist if you don't have a thing for cutting specimens?

Thank you everyone who took the time to read my post and maybe share your opinion!

Hey there,

I think for most AP training programs around the world, registrars / residents will be expected to do grossing of small and big specimens,
whether it be for exposure, or as service provision. The amount of grossing duty really varies by the training lab. There are some labs where you only have to gross 1 day / week, and others where you gross 5 days / week. In some labs that have less grossing duties, I imagine that there may be other responsibilities, such as assisting in frozen sections, attending FNAs, doing autopsies, and/or presenting at MDMs / tumour boards.

I understand that in some labs, there are PAs (Pathologist Assistants) or scientists who can do biopsy transfers and cut small specimens (and possibly big specimens too).

I think it's important to know how to gross a specimen because it facilitates the histology interpretation. But eventually, there are diminishing returns. For example, you don't really need to gross 10000 appendices to know what acute suppurative appendicitis or appendiceal NET / carcinoid looks like under the microscope... Once you gross 100 appendices, every appendix afterwards feels more like a "chore". The same can be said of gallbladders, skin ellipses, placentas, bowels, breasts, many specimens really.

IMHO, if you're in a lab / training program with a very heavy grossing load as part of service provision, this will take time away from your reporting time during working hours, which will slow down your acquisition of histopathology knowledge, which isn't ideal. Of course, you can always practice reporting cases after work and over the weekend, but there's only so much you can do outside of work, especially when you need to study for exams outside of work too.

Re: the actual enjoyment of grossing, for large specimens specifically, I personally enjoy grossing tumour bowels. I have grossed at least 200 tumour bowels, so it has become relatively straightforward for me. At a personal level, I enjoy cutting the tumour and seeing where the deepest point of invasion is, and the distances from the various margins. Oh and searching for lymph nodes, I pretend it's like a "treasure hunt" :p. I personally find grossing tumour bowels a lot more straightforward than grossing tumour mastectomies, as the bowel tumour is much more delineated.

Grossing specimens is an important part of AP. If you gross a specimen incorrectly, it can hamper the histological interpretation, or at worst, preclude the analysis. But as I said above, after a while, it feels more like a "chore" as part of service provision.
 

yaah

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It might be a little unusual to enjoy grossing, but it's certainly not unheard of. You have a bunch of work, every case is different, and you see all kinds of different things. There is a lot of routine and manual work too - if you are someone who likes routine and such, you might enjoy it. At times I enjoyed it too.
 

fecalith

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Aug 26, 2018
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I have been really enjoying grossing so far. However, I came from a heavy pathology background with grossing and autopsies included in my medical school curriculum and with a forensics focus. I also worked in the restaurant industry both in prep and as the head chef for several years and did a lot of fine butchering (hence the username CGM aka Certified Grill Master)...So I wouldn't say I represent the average demographic sample of pathology residents. I just love the hands on, practical aspect of grossing/sectioning and the variety of specimens.. even the routine/boring ones.
 
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Guest8

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Other than a very small private practice with limited volume I can't think of a good reason to have an attending pathologist do grossing. It always makes sense for the pathologist to do what brings in the most revenue for the practice - sign out cases. PA's can be employed for right around 100K, and grossing techs are far less than that (40-50k). You'll more than make up the salary of a PA or grossing tech in the added time you can sign out more cases.
 
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doctor313

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I also found grossing to be unappealing at first, but as was said earlier, you get desensitized pretty fast after a couple weeks of grossing / autopsies. Then, you start to realize why the things you are doing when you gross / do autopsies are important, and after that, I personally began to enjoy it. I never thought I would have enjoyed autopsies or grossing when I started residency, and some people never seem to enjoy them, but I may be one of the lucky ones. With that said, I'm perfectly happy working at the scope and would gladly take a job with or without grossing / autopsy duties because of it.
 
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RE-Tired

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I believe being able to gross specimens (especially resections) is integral to becoming a well rounded pathologist, so you do not need to like it but it is better to be in a program that gives the resident extensive grossing experience. As a pathologist trained in the 80s where I did 100% of the specimens for the first 3 years, I acquired excellent skills and speed. We got a tech in my last year to do the biopsies thank goodness. I realize today that PA's are an integral part of pathology and that will not change. The gist of what I am saying is that in your first year you should hone your grossing skills and then whatever grossing that you have to do in future will be easier for you. Good luck.
 
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y2k_free_radical

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Sep 25, 2015
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Hello everyone,

I've searched the forum but I haven't found anything similar answering my question so I went ahead and made this thread.

So after extensive research and soul searhing I've reached the conclusion that pathology is the only specialty which suits me(maybe rads a very distant second).The positives are numerous i.e intellectually stimulating,no patient contact,I'm way more into the science than practising medicine,no social medicine bs,hated anything after pre-clinical years etc

I scheduled a shadowing week to figure out what I would be getting myself into before commiting.What I've gathered is that I thoroughly enjoy spending time at the microscope but I can't say the same about grossing;I felt very disconnected and a bit grossed out e.g cutting through mastectomies made me feel uneasy.I understand that no job is perfect but I'm trying to figure out how big of a part grossing is in the daily grind.

Does anyone else relate to what I'm describing?Did you initially disliked grossing but then you started enjoying it?Is it possible to become a good pathologist if you don't have a thing for cutting specimens?

Thank you everyone who took the time to read my post and maybe share your opinion!
I suggest you watch the 1964 movie "DR STRANGELOVE or:HOW I LEARNED to STOP WORRYING and LOVE the BOMB ".I see many parallels.
 

CDX-2

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I am not sure what is worse, grossing or hostile surgeons who think they took out more lymph nodes than they actually did.

In the labs I've worked in so far, most surgeons will be content if you find at least 12 lymph nodes for a tumour bowel.

If the bowel tumour is T1, you might be able to get away with 11 or even 10 lymph nodes.

What's more frustrating is if there's a very large mastectomy and they mention 1 tumour on the request form,
but then several days after you gross it, they say there's a possible (much smaller) 2nd tumour (which they DIDN'T mention on the initial request form),
and so you have to go back and submit more sections just to verify the existence of said hypothetical 2nd tumour...
 

mikesheree

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In the labs I've worked in so far, most surgeons will be content if you find at least 12 lymph nodes for a tumour bowel.

If the bowel tumour is T1, you might be able to get away with 11 or even 10 lymph nodes.

What's more frustrating is if there's a very large mastectomy and they mention 1 tumour on the request form,
but then several days after you gross it, they say there's a possible (much smaller) 2nd tumour (which they DIDN'T mention on the initial request form),
and so you have to go back and submit more sections just to verify the existence of said hypothetical 2nd tumour...

You cannot make chicken soup out of chicken s***.
 

CDX-2

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You cannot make chicken soup out of chicken s***.

Lol I just googled that phrase and they say "You cannot make chicken salad out of chicken ****."

But yeah, I understand surgeons can be very busy,
but it would've been courteous if they listed all of the possible tumours and their locations on the request form,
instead of expecting the pathology registrar / resident to play "hide and seek",
especially if it's a tiny T1 tumour in a very large mastectomy.

Oh well, the finalized report will get delayed...
 

alpinebrook

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Short answer is no, you don't need to like grossing to be a pathologist (if you otherwise love the rest of pathology). However, you very much need to learn how to do it proficiently. But you're in good company if you'd rather stay at the microscope!
 

LADoc00

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Folks grossing sucks even after 40 years. I had an old guy tell me recently when he finally hung up grossing forever after 40 (!) years, it was one of the best days of his life.
 
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KeratinPearls

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Maybe formalin isn't so bad for you after all

Get this:

Where I did my residency, there were no fume hoods at all. We were breathing formalin in when we were grossing (colons stored overnight for fixing made me tear many times). Autopsy suite had no hoods. We routinely breathed in formalin when we opened containers of stored organs.

It wasn’t until my 4th year that they installed hoods. Unbelievable right? The attendings there were working like that for 20+ years.

If you guys don’t hear from me again, You know what happened to me.
 
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coroner

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It wasn’t until my 4th year that they installed hoods.

Dang, don't know when you graduated...1977?

But, I still have to gross, and it's more common in private practice, particularly in smaller hospitals. However, I can't see myself doing it for 40 years when all is said and done. Although some of the former partners in our group who retired in the last couple of years did...:meh:
 
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WEBB PINKERTON

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I have done many inspections over the years and I am not surprised. I have cited quite a few labs for fumes and unsafe conditions. Once saw an in-office lab that was basically a converted broom closet. The fumes were unbelievable in a very tight space. Couldn't figure out how the histotech and pathologist worked in there. I need to check the literature to see how many former paths, histotechs, PAs ended up with neurological disorders and cancer. Wonder if there are any studies?
 

KeratinPearls

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I have done many inspections over the years and I am not surprised. I have cited quite a few labs for fumes and unsafe conditions. Once saw an in-office lab that was basically a converted broom closet. The fumes were unbelievable in a very tight space. Couldn't figure out how the histotech and pathologist worked in there. I need to check the literature to see how many former paths, histotechs, PAs ended up with neurological disorders and cancer. Wonder if there are any studies?

modern day sweatshops sadly. I knew of some pathologists that have died of gbm prob just a conincidence though. One was younger in her 40s.
 

gbwillner

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No this is fairly recent. I was surprised when I left, I never knew fume hoods were a thing as we never had any. I was shocked to realize how long I was exposed to formalin and how long the Department went Without hoods.
We also did not have fume hoods in our grossing area, but were told the ventilation of the room itself was sufficient. I'm not sure what the health hazards to formalin and xylene are, but to my knowledge they are not carcinogenic. I bet our lungs will be nicely preserved though, when we are dug out of the ground for alien sport trophies in the distant future.
 

HeyDalaron

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We also did not have fume hoods in our grossing area, but were told the ventilation of the room itself was sufficient. I'm not sure what the health hazards to formalin and xylene are, but to my knowledge they are not carcinogenic. I bet our lungs will be nicely preserved though, when we are dug out of the ground for alien sport trophies in the distant future.

Formalin is most likely carcinogenic in humans.

 

KeratinPearls

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Formalin is most likely carcinogenic in humans.

Yup a few years back formalin was classified as carcinogenic and afterwards I began thinking about all the times my eyes teared up from breathing in concentrated formalin from stored organs.
 

alpinebrook

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On more than one occasion during residency, I'd get a very small tear in my glove and not realize it -- continue grossing for however long -- only to realize that my finger was soaking in formalin the whole time. It would instantly turn prune-y when I washed my hands or took a shower, but went away after a day or so.
 
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