Anyone here at the meeting?
How was the Residents Forum?
The poster session seemed dead. Is that how it usually is?
How was the Residents Forum?
The poster session seemed dead. Is that how it usually is?
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Cap 2010
Started by KeratinPearls
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lol! thats how it was last year -- i stood by my poster for 20 mins like an idiot
CAP poster sessions are designed to get trainees to the meeting and get them involved with the networking component. There is usually not a significant emphasis on poster sessions. At USCAP, where is it much more difficult to get an abstract accepted, poster sessions are much more lively and well attended.
any meeting that accepts case report abstracts is a joke. don't need to see posters on the eleventh reported case of ____.
Hmm....well (insert transformational platitude here) and you pretty much have all of the residents forum.
I agree the poster session was a little lacking, I got so much more out of just chatting with random folks.
That bad, huh? Sorry to hear that. Any suggestions for improvement?
How about explaining what was so bad about pathology before and what it supposed to be transforming into and why that would be better. No one has ever actually explained that very clearly.
A lot of time was actually spent on this several years ago when the whole "transformation" agenda got started. The basic idea is that because of the coming changes in medicine (read, changes in reimbursement), our current headquarters in the proverbial sub-basement of the hospital may not be the most desirable real estate next time they divide the pie.
How do you mean? Rounding with clinicians will prevent a decline in medicare reimbursement?
I still don't understand what transformation means. Is it only rounding with clinicians, or was there more to it?
I think pathologists are afraid for their jobs for two reasons: potential outsourcing, and potential technological innovations rendering traditional morphology obsolete. Hence the repeated focus in CAP TODAY president's column on making yourself relevant and useful. I don't buy a lot of it, but I do think CAP should be working to identify future problems with the field and coming up with remedies. But how about more specific, concrete remedies that don't require vague terms like "transformation."
I think the way people (and I mean both the critics and proponents of the "transformation") keep focusing on "rounding with clinicians" is a mistake. Most of us have bad memories of time wasted staring at our navels on hugely inefficient walking rounds as medical students. The suggestion that we return to doing this is absurd. It makes the whole concept of the transformation seem ridiculous, and I think that's unfortunate.
In my mind, the main idea of the "transformation" is this: Pathologists should make themselves visible members of the health care team, both to clinicians and patients. As I see it, the reason we'd like to do this is that, as a profession, we'd like to avoid the commoditization of our services and avoid giving the impression to clinicians, patients, and bureaucrats that pathologists are interchangeable parts. Rounding with clinicians and doing other similarly visible activities give us a face, both to the patients and to the clinicians.
As another example, take the currently hot concept of the "medical home" that people think may end up being the new model of government-influenced health care. Most people think of the general practitioner as being the gatekeeper of the system, controlling referrals, etc. The "transformation" perspective would be that, as the keepers of lab data, pathologists are uniquely positioned to take a leadership role in the overall care of the patient.
A third reason would be the rise of molecular testing in cancer diagnosis. There is a lot of fear out there that molecular testing could significantly diminish histopathology's traditional central role in cancer care. Cancer diagnosis and prognostication would become the realm of the PhD and the oncologist, and pathologists would get cut out of the loop. I don't see this happening in the near future, but twenty or thirty years from now, I guess it could.
In general, I think the transformation is a valuable initiative. However, I guarantee you I won't be doing walking rounds with the ****ing internists while I have a mountain of slides waiting for me in my office.
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Pathologists have lots of opportunities to educate clinicians and therefore become a more visible part of the team. The ones I see everyday get tired of trying and eventually acquiesce to their every request; such as providing a Nottingham score on lobular breast carcinomas or reporting capsular invasion of the prostate. I understand it - 10 minutes with a clinician can not only be irritating, but is also time I could spend signing out my cases in order to enjoy the 8-5 pathologist lifestyle. What are we to do?
Well... If there is ever a sensitive and specific battery of blood tests developed that can diagnose a patients tumor without the need for any interpretation by a pathologist, and one that makes traditional morphology useless, that would be a great day for patients. That is a diagnostic magic bullet.
That will happen around the same time every tumor has a targeted treatment and patients will no longer need an oncologist either, family practice will do just fine, once they get the automated diagnosis emailed to them from the lab.
Actually, inasmuch as advances in molecular biology could make a lot of current medical expertise obsolete, it kind of seems that pathology is pretty well positioned. Pathologists run the lab, right?
I'm not too worried about this sort of thing though. It seems a little overly optimistic for me. I guess that with the rate that science is progressing, it's impossible to predict what any field in medicine will look like in 30 years. It seems likely to me, though, that as the science of molecular diagnosis progresses the expertise of pathology will be in greater, not lesser, demand.
That will happen around the same time every tumor has a targeted treatment and patients will no longer need an oncologist either, family practice will do just fine, once they get the automated diagnosis emailed to them from the lab.
Actually, inasmuch as advances in molecular biology could make a lot of current medical expertise obsolete, it kind of seems that pathology is pretty well positioned. Pathologists run the lab, right?
I'm not too worried about this sort of thing though. It seems a little overly optimistic for me. I guess that with the rate that science is progressing, it's impossible to predict what any field in medicine will look like in 30 years. It seems likely to me, though, that as the science of molecular diagnosis progresses the expertise of pathology will be in greater, not lesser, demand.
Except that pathologists don't run "the lab" -- not exclusively, and not in large numbers. One pathologist might be medical director, with non-MD PhD's running all the various departments. So yes, while in one version of The Future results might come from automated systems at The Lab, which loosely equals pathology (the specialty), I don't see that that equates with pathologists (the people & the jobs) being well positioned.
But, the current state of molecular diagnosis & treatment is barely in the fetal stage, and there are a few series of malformations, deformations, and terminations to go through before it's useful outside of very narrow circumstances.
But, the current state of molecular diagnosis & treatment is barely in the fetal stage, and there are a few series of malformations, deformations, and terminations to go through before it's useful outside of very narrow circumstances.
My suspicion is that if you are in a good academic center or a strong community practice you are likely already "transformed" to some degree. You have to be in order to practice pathology well- doing tumor boards, being on a first name basis with clinicians, participating in multi-disciplinary conferences, etc, etc.
I think the issue of who actually owns lab data is a contentious one. I am not sure that, when push comes to shove, pathologists can claim that they "own" the CBC's, Chem 10's, thyroid panels, etc, etc. Although controlling the distribution and information systems is a strong starting point.
I think the issue of who actually owns lab data is a contentious one. I am not sure that, when push comes to shove, pathologists can claim that they "own" the CBC's, Chem 10's, thyroid panels, etc, etc. Although controlling the distribution and information systems is a strong starting point.
I guess this is a little off topic, but to what extent can ordering a lab test be considered a pathology consult?
Maybe ordering a Chem 10 doesn't need a pathologist to be involved, but what about a hemoglobin electrophoresis, or another more complicated test? Are these properly ''consults'' which the pathologist can refuse?
It seems like one of the roles of pathology should be to prevent clinicians from ordering inappropriate tests. Like when they order some invalid molecular battery, it should automatically be seen as a pathology consult where the pathologist should refuse it and order the appropriate test instead. Is this what ''transformation'' is supposed to be?
Maybe ordering a Chem 10 doesn't need a pathologist to be involved, but what about a hemoglobin electrophoresis, or another more complicated test? Are these properly ''consults'' which the pathologist can refuse?
It seems like one of the roles of pathology should be to prevent clinicians from ordering inappropriate tests. Like when they order some invalid molecular battery, it should automatically be seen as a pathology consult where the pathologist should refuse it and order the appropriate test instead. Is this what ''transformation'' is supposed to be?
This happens a lot in some areas of CP and is a useful way to think about the role of pathologists. A clinician may ask for all of the 5 bacteria to be worked up from the primary culture of a sputum, but the lab will refuse. Or at VA hospitals where any test over a certain amount of money has to be approved. Occasionally a test gets changed to the more appropriate one. But it is not possible to review every test as it is ordered, there are far too many.
I think this pretty much sums it up. Maybe the idea of rounding was focused on by some at first, but I think that might have been mentioned as a possible idea for ways to become visible and useful as pathologists. The transformation agenda has been pretty vague for a while now, but now I feel that CAP is finally getting some concrete ideas behind this initiative.
I think the discussion here makes many good points:
1. Visibility and recognition by other doctors and by the public may actually help our specialty to have a seat at the table when reimbursement is discussed. Obviously, no one controls the CMS (Medicare), but I think that visibility might put us on a level with our other clinical colleagues.
2. 2121115 makes a great point: Many pathologists are already "transformed", especially younger trainees and new in practice. But many, many pathologists seem to feel that they won't need to change with the times. They will retire before all of this stuff happens. That kind of attitude can define the culture of our specialty, which means that when new technologies really do take off, we will be left in the dust.
3. Molecular path is a great example of the above point. Maybe nobody really knows how important it will turn out to be, but if we don't claim ownership of this (and other new technologies), we will lose it to other specialties who will come in to fill the vacuum. I think a big goal of the transformation idea is to get pathologists to keep their heads out of the sand and to be willing to prepare and change as needed to meet new clinical and technological demands.
"Transformation" sounds cliche and trendy, I agree. But I think part of the goal is to shake things up so that those "old timers" (or anyone else who is just trying to stay the course and not learn new technologies or new ways of interacting with other health care providers or even patients [gasp!]) will wake up and realize that if we don't lead and own the things that belong to our field, we very well might lose them. Just my take on it.
Oldest trick in the management/administration book of "making money without doing anything becuase of laziness and low IQ".
If you are totally impotent and cannot do anything worthwhile, just throw in some new words like "transformation" and confuse all the other idiots that you really are doing something.
Pathology is full of loser types. Do not be one. Be smart and see through all the BS.
If you are totally impotent and cannot do anything worthwhile, just throw in some new words like "transformation" and confuse all the other idiots that you really are doing something.
Pathology is full of loser types. Do not be one. Be smart and see through all the BS.
