Clinician misconceptions about Pathology

[Enkidu]

The average Joe may not know what a pathologist is, but he learned everything he knows about medicine from watching Scrubs and Grey's Anatomy. I have relatives who insist that their biopsy was read by a machine and not a human, that coagulation studies are performed in a little back room somewhere and overseen by the treating clinician, and that ABO compatibility is the only thing you really have to consider when transfusing red cells. Most people think there is a disease called "cancer" that comes in one flavor equally affecting different organs. There are abundant misconceptions and that is fine. What is embarrassing is when a clinician has misconceptions about what a pathologist does and does not do, how diseases are diagnosed, how to properly use a laboratory study, etc. In surgical pathology alone, the volume of information we need to cram into our heads is too much for any clinician to have time to memorize. Patients want to know what they have and not what the clinical impression dictates, so as long as physicians want to look smart and make accurate decisions, then they need to partner with pathologists.

Hey, I noticed this statement in another thread and it made me wonder about clinician misconceptions about pathologists. I had always thought that clinicians, being the ones who consult pathology, knew what pathology was all about. Maybe this isn't the case. Can anyone give some examples of misperceptions that clinicians have about pathology?

---

Members don't see this ad.

 

[gbwillner]

I once had a Heme-Onc friend of mine ask me:
"why do you guys always just give us one diagnosis? Why can't you provide a differential like Radiology?"

My response was..... Uhhhhhhhhh seriously?

 

[pathstudent]

I once had a Heme-Onc friend of mine ask me:
"why do you guys always just give us one diagnosis? Why can't you provide a differential like Radiology?"

My response was..... Uhhhhhhhhh seriously?

Yeah how about the differential for this bone marrow biopsy is ALL VS AML VS HIGH GRADE LYMPHOMA VS HIGH GRADE CARCINOMA VS UNUSUAL BENIGN PROCESS.

 

[gungho]

Hey, I noticed this statement in another thread and it made me wonder about clinician misconceptions about pathologists. I had always thought that clinicians, being the ones who consult pathology, knew what pathology was all about. Maybe this isn't the case. Can anyone give some examples of misperceptions that clinicians have about pathology?

When I was leaving my large multi-site, multi-specialty group as a Family Practitioner to enter Pathology residency, I told the medical director of my group (an internist about my age, 47) what I was doing. He said, "what are you going to do, sit around in a lab all day?"

 

[caffeinegirl]

I thought I sometimes get crappy calls from clinicians because I'm relatively young in my career. But I guess it doesn't get any better.
I'm part of "Pathology Network" on lww.com, and Stacey Mills has a blog on that network, which is pretty good.
Looks like being the editor to AJSP, and a world expert in head and neck surg path doesn't preclude you from getting hassled by these crappy calls.

Anyway, he recently posted this
(original link to subscribers: http://networks.lww.com/pathology/blog/pnblog/pages/post.aspx?PostID=39)


(Quoted transcript below)
In my last blog, I mentioned our role to combat patient and naive clinician exploitation by molecular profiling labs with tools of dubious value. This is not an easy job. Here's one of my recent failures in this regard.

Like most consultants with an interest in head and neck, I get a lot of thyroids for review and a month or so ago I had one that was a straightforward follicular variant of papillary carcinoma. A week or so after signing it out I got a call from the patient's clinician in a nearby town. So far so good. The clinician wanted to know if we had assayed the tumor for BRAF mutations. When I said we hadn't the trouble started.

I was well aware of increased interest in BRAF because of its new role in promising targeted therapy of malignant melanomas with this mutation, and we are part of the evaluation of this at UVa, so the assay gets done on most of our melanomas. I was also aware of a few papers showing some decreased survival for papillary thyroid carcinomas with BRAF mutations, but the differences were, at least in my view, minor in a tumor with an overall excellent prognosis, and it was unclear if they held up in rigorous multivariant analysis when controlled for stage and some known more aggressive subtypes. Moreover, there is already a superb targeted therapy for thyroid carcinoma..... radioactive iodine.

The conversation went just about like this (honest!):
C = clinician
M = me

C: Did you assay Ms. X's thyroid carcinoma for BRAF?

M: No, we don't do that.

C: Why not? I want it done in this case. Can you do it?

M: Your pathologist has the block. If you really want it done, talk to him.

C: Why can't you do it?

M: Because it's expensive and of no therapeutic value.

C: That's not true, it's a great prognostic marker.

M: Really? That's not my read on the literature. It seems to be at least in part a surrogate marker of high stage or poorer prognosis subtypes like tall cell. Anyway, even if it did have limited prognostic value for these usually cured tumors how would it affect your therapy? There's already GREAT therapy; surgery and if needed radioactive iodine, the mother of all targeted therapies.

C: I can't believe you don't do this. They do it on all their thyroids at Elsewhere Memorial. (They DON'T, I checked.). You guys call yourselves an academic institution and you're SO behind the times on this.

M: Tell me how you would use this information. This was a small encapsulated tumor with an excellent prognosis, regardless.

C: I can't believe you don't do this! I'm going to send you some papers so you can come into the 21st century.

M: You haven't answered my question. Every test should have a clinical branch point or else it's of no value.

C: I'll send you the papers, then you'll see.

-Hang-up-

I never got the papers. I must admit this call left me feeling a little "inadequate" and sent me running to do a quick literature search and make a call to a friend at Elsewhere Memorial to see if the world had unknowingly passed me by on this. But it hadn't. Mainly, I was depressed at my inability to convince a private practice clinician that just because a test is available doesn't mean it's needed or indicated. At best this is probably a repetitive process, easier to do with clinicians you see every day in your own institution.

I was again reminded of Ben Goldacre's admonition in Bad Science that you can't reason someone out of a position they didn't use reason to get into. Unfortunately, we'll have to deal with issues like this more and more. If these excesses come under Medicare scrutiny the result is likely to be across the board reimbursement cuts including expensive items that ARE of clinical value.

 

[Pathwrath]

I thought I sometimes get crappy calls from clinicians because I'm relatively young in my career. But I guess it doesn't get any better.

I knew you were a relatively new attending because you tried so hard to educate an obnoxious clinician. Good for you. Pearls before swine, but good for you for trying.

My response to this kind of repartee is usually silence and a wan smile. If I'm feeling energetic, I sound like Willy Wonka pretending to care whether Mike Teavee shrinks himself:

"Stop. Don't. Come back."

 

[Ishie1013]

Only just matching to path (hooray!) but upon telling people in clinicals that decision:

Surgeon: So you have no problem just being a lab rat?
Anesthesiologist: I think I would have really liked pathology but don't you have to do tons and tons of autopsies? I don't think I could do that.
FP: Why don't you just do heme/onc?

 

[DOtoCanada]

Only just matching to path (hooray!) but upon telling people in clinicals that decision:

Surgeon: So you have no problem just being a lab rat?
Anesthesiologist: I think I would have really liked pathology but don't you have to do tons and tons of autopsies? I don't think I could do that.
FP: Why don't you just do heme/onc?

This, times every single rotation. Ug.

 

[smallcat]

Or this: "Don't you really miss patient interaction?" Uh, no.

 

[gschl1234]

Only just matching to path (hooray!) but upon telling people in clinicals that decision:

Surgeon: So you have no problem just being a lab rat?
Anesthesiologist: I think I would have really liked pathology but don't you have to do tons and tons of autopsies? I don't think I could do that.
FP: Why don't you just do heme/onc?

Back when I matched:
FP: What do pathologists do, anyway? Oh, I guess there's the lab stuff.
Anes: Great field. The doctor's doctor.
Psych: Are you *sure* you don't want to be a psychiatrist?
Derm (resident): I thought about doing it, but I can't handle the autopsies so I'm going into dermpath.
Rads (resident): Path is OK, but you don't make enough money.

 

[KCShaw]

All from physicians of various ages and specialties, though mostly paraphrased:

About pathology in general:
"Those people are so weird.." Oh, you've met some? "Met who? I wouldn't know where to find one. Where's the morgue?"
"Ugh, I couldn't sit in that lab all day running machines. I wasn't that much for research anyway."
"Gross, I couldn't eat while doing an autopsy."
"You mean like CSI?" ..tried to explain that while I liked forensic path, most pathologists aren't involved in that at all.. "Oh, so what do they do?" ..tried to explain further.. "Huh, the lab..so why did you go to medical school?"

Then after I told people I was interested in forensic path:
"You mean like Scully?"
"You mean like Quincy?"
"You mean like Dr. G?"
"You mean like CSI?"
"You really want to interrogate murder suspects?"
"Do you carry a gun?" (Yes, two mighty biceps.)
"I couldn't work in a police department."

 

[Waywoe]

Back when I was torn between path and gas, I was having a discussion about both specialties with my school-appointed adviser. I was disappointed to find out that he felt that pathologists were overpaid necrophiliacs. Can't wait to see what he puts in my Dean's letter.

 

[SaltySqueegee]

Back when I was torn between path and gas, I was having a discussion about both specialties with my school-appointed adviser. I was disappointed to find out that he felt that pathologists were overpaid necrophiliacs. Can't wait to see what he puts in my Dean's letter.

 

[Entgegen]

I was disappointed to find out that he felt that pathologists were overpaid necrophiliacs.

Given that he thinks they're overpaid, did you happen to ask what he thought adequate compensation for being a necrophiliac was?

 

[HbyHA]

All from physicians of various ages and specialties, though mostly paraphrased:

About pathology in general:
"Those people are so weird.." Oh, you've met some? "Met who? I wouldn't know where to find one. Where's the morgue?"
"Ugh, I couldn't sit in that lab all day running machines. I wasn't that much for research anyway."
"Gross, I couldn't eat while doing an autopsy."
"You mean like CSI?" ..tried to explain that while I liked forensic path, most pathologists aren't involved in that at all.. "Oh, so what do they do?" ..tried to explain further.. "Huh, the lab..so why did you go to medical school?"

Then after I told people I was interested in forensic path:
"You mean like Scully?"
"You mean like Quincy?"
"You mean like Dr. G?"
"You mean like CSI?"
"You really want to interrogate murder suspects?"
"Do you carry a gun?" (Yes, two mighty biceps.)
"I couldn't work in a police department."

ditto here.

 

[BrainPathology]

Where did all you guys go? I got

"wow path they're the smartest dr's in the hospital"
"the pathologists here seem to have a great time and we love working with them, way to go"

Yeah a couple "why do you want to do autopsies", "won't you miss patient care" nonsense but generally the clinicians who said these things also had little to say of value about anything else so it wasn't a surprise.

 

[KCShaw]

We could also have a thread about those clinicians who -do- have a clue what pathology is and what they've said about it -- it just wouldn't be as much fun. Certainly I've run across those individuals too. Actually, I've even had a couple of non-MD's get absolutely giddy about "the doctor's doctor" when I mentioned pathology, and clearly SOMEHOW knew a very reasonable amount about the profession.

It just happens that, for the most part, I recollect non-pathologists (especially non-surgeons, non-heme/oncs) having only a marginal understanding of what a typical AP/CP pathologist is or does, and off-the-wall comments tend to stick out a lot more than reasonable ones. Heh.

 

[BrainPathology]

We could also have a thread about those clinicians who -do- have a clue what pathology is and what they've said about it -- it just wouldn't be as much fun. Certainly I've run across those individuals too. Actually, I've even had a couple of non-MD's get absolutely giddy about "the doctor's doctor" when I mentioned pathology, and clearly SOMEHOW knew a very reasonable amount about the profession.

It just happens that, for the most part, I recollect non-pathologists (especially non-surgeons, non-heme/oncs) having only a marginal understanding of what a typical AP/CP pathologist is or does, and off-the-wall comments tend to stick out a lot more than reasonable ones. Heh.

Yeah if I strain I can probably remember more silly things then the good comments I mentioned. But maybe I'm just far far too optimistic and remember these encouraging things more.

 

[Ishie1013]

If it helps the positive vibes love, when I was doing a neurosurgery elective, the surgeon stated repeatedly how proud he was that I was doing path and how smart I was for not doing neurosurgery.

Though that may have been more a reflection on NS than path...

 

[shan564]

Hey guys, I'm a med student thinking about pathology as a career choice... and this thread is dynamite.

Every time an attending or a resident asks me "what do you want to be when you grow up?" and I say "Academic pathology", they give me a funny look and respond exactly the way that everybody on this thread has mentioned. My favorite was an oncologist who used the word "stupid" to describe the entire field of medical research. They actually made me reconsider - I started to think "maybe I will miss patient contact... maybe I do really want to follow up on my patients and build long-term relationships... maybe research is more boring than I remember... maybe I should just compromise a little bit and go into clinical hematology..."

Anyway, thanks for reaffirming my faith in pathologists.

 

[Pedsbro]

I'm also interested in Path, but as I head into 3rd year clerkships in a few months, I do worry about the stigma. Do you recommend withholding my interest in path if asked what I want to go into? I can honestly say I don't know for sure (there are other specialties on my list, but path is #1), but there will come a time when they would expect me to have made the decision already. Or just be up front with it and let them say whatever they want? Are there docs out there petty enough to knock me down a few points or give me a bad eval based on my career decision?

 

[twentyone]

I'm also interested in Path, but as I head into 3rd year clerkships in a few months, I do worry about the stigma. Do you recommend withholding my interest in path if asked what I want to go into? I can honestly say I don't know for sure (there are other specialties on my list, but path is #1), but there will come a time when they would expect me to have made the decision already. Or just be up front with it and let them say whatever they want? Are there docs out there petty enough to knock me down a few points or give me a bad eval based on my career decision?

Pathology is nothing to be ashamed of. Don't NOT tell people what you're going into. You may become their "lab connection" and become more useful to the team. Just be awesome and show them that superstars go into pathology too.

 

[Enkidu]

I'm also interested in Path, but as I head into 3rd year clerkships in a few months, I do worry about the stigma. Do you recommend withholding my interest in path if asked what I want to go into? I can honestly say I don't know for sure (there are other specialties on my list, but path is #1), but there will come a time when they would expect me to have made the decision already. Or just be up front with it and let them say whatever they want? Are there docs out there petty enough to knock me down a few points or give me a bad eval based on my career decision?

Well I don't think that there is necessarily a stigma about going into pathology, just a poor understanding of what pathologists do. The stereotype about pathologists is that they're nerdy and can't relate to patients... not that they're stupid or useless. I think that there is a worse stigma about going into psychiatry, or even family medicine.

I'm an aggressive advocate for pathology. When people tell me that I won't have any patient contact, I remind them that a "patient" is just an obese or elderly stranger who they have nothing in common with. I prefer to have contact with people that I might actually like, like other physicians. When they protest that most conditions are not diagnosed by pathology, I point out that even if clinicians get to make some diagnoses, even ignoring that they rely on laboratory tests, the majority of their career is spent managing chronic disease, not diagnosing it.

My favorite is when people say that pathologists don't get to treat patients. Who cares? They get to do one better: The clinician bases their entire treatment on the pathologists diagnosis. Do some people think that it is more interesting to prescribe imatinib than it is to diagnose CML? I can almost not even comprehend that.

 

[KCShaw]

Yeah, I agree that stigma is not the right word. As with any declaration that one is going into X, you run the risk of your supervisor losing interest in teaching you THEIR field while you're on their rotation, but that's no reason to lie to them. I always told people what I was most interested in, in an open-door sort of way rather than announcing that's all I was gonna do and to hell with everything else. And if you tell them straight, you may get both your training and any references better tailored to you and your interests.

To be perfectly honest I faced more problems in residency the more I settled on forensic pathology rather than typical surg path or one of its underlings than I ever remember facing on student rotations. Not that I felt I lost anything in references or evaluations, but it can change how people work with you (and you with them).

 

[Pedsbro]

Yeah, I agree that stigma is not the right word. As with any declaration that one is going into X, you run the risk of your supervisor losing interest in teaching you THEIR field while you're on their rotation, but that's no reason to lie to them. I always told people what I was most interested in, in an open-door sort of way rather than announcing that's all I was gonna do and to hell with everything else. And if you tell them straight, you may get both your training and any references better tailored to you and your interests.

To be perfectly honest I faced more problems in residency the more I settled on forensic pathology rather than typical surg path or one of its underlings than I ever remember facing on student rotations. Not that I felt I lost anything in references or evaluations, but it can change how people work with you (and you with them).

Thanks! I also agree stigma was the wrong word for me to use...I couldn't think of a better word to summarize all the misconceptions and inaccurate reputations of the field and what pathologists do. But I have heard a few stories similar to what some of the posters have said, where students interested in pathology get a little heat about it from attendings/clerkship directors in other specialties....people that those students were hoping to get letters from. In any case, I've never cared much about what other people think of me or of what I want to do, but I do care if they are petty enough to give me a negative evaluation or brush me off based solely on the fact that I want to go into a field they don't understand or like. At my school, and I'm sure at most, the subjective part of clerkship evals are 60%+ of the total grade, so I think it's a legit concern, but maybe not as serious of a problem as it's being made to be??

 

[Ishie1013]

I'm also interested in Path, but as I head into 3rd year clerkships in a few months, I do worry about the stigma. Do you recommend withholding my interest in path if asked what I want to go into? I can honestly say I don't know for sure (there are other specialties on my list, but path is #1), but there will come a time when they would expect me to have made the decision already. Or just be up front with it and let them say whatever they want? Are there docs out there petty enough to knock me down a few points or give me a bad eval based on my career decision?

I was fairly up front about it once I'd made my decision. How you present it kind of depends on how you feel up the attending. I'm female, so one the most aggravating misconceptions I got was that I'm going into the field so I can have plenty of time to make babies, since clearly that's the only reason I'm not going into peds or ob.

It ends up being really good some times. When I did a derm elective, I told the attending, and she went "Oh! I spent the first year of my residency behind a microscope!" and for every patient, explained the general presentation of the illness for everyone's benefit, and added a "And on biopsy, you'd see _____, ________ or _______, which is indicative of _____" for my benefit, which was pretty awesome. If I'd clammed up, she wouldn't have included it. Similar experience in peds heme/onc. They tried to tailor teaching me to my specialty, and ended up sort of inadvertently hooking me on hemepath.

I wasn't docked by any attending to the best of my knowledge. Really, the only penalty for telling them was that socially awkward pause where they'd try to figure out a response.

 

[Enkidu]

I always told people what I was most interested in, in an open-door sort of way rather than announcing that's all I was gonna do and to hell with everything else. And if you tell them straight, you may get both your training and any references better tailored to you and your interests.

Yeah, I. Guess I should clarify my previous post. I described how I tell other students that I want to go into pathology. With attendings I just tell them pathology and I've gotten a few good-natured jokes, but nothing bad. Mostly they tell me that pathologists are the smartest doctors in the hospital, with a caveat that they have very little clinical acumen.

 

[zao275]

When I did a derm elective, I told the attending, and she went "Oh! I spent the first year of my residency behind a microscope!" and for every patient, explained the general presentation of the illness for everyone's benefit, and added a "And on biopsy, you'd see _____, ________ or _______, which is indicative of _____" for my benefit, which was pretty awesome. If I'd clammed up, she wouldn't have included it.

Cool story!


Most attendings were very supportive of my interest in path, and I was always very open with them about it, but I still tried to learn and work hard on whatever service I was on.

One surgeon said: "A good pathologist who doesn't hedge is worth his weight in gold." I took it as a complement but I noted the not so subtle comment couched in the middle!

 

[KCShaw]

An accurate pathologist who doesn't hedge might be worth their weight in something nice. But confidently being wrong is, I daresay, much worse. But absolutely, being prompt, accurate, and definitive -- especially with surgeons -- will certainly help with marketing and the grapevine.

 

[shan564]

One surgeon said: "A good pathologist who doesn't hedge is worth his weight in gold." I took it as a complement but I noted the not so subtle comment couched in the middle!

Show me a pathologist who doesn't hedge, and I'll show you a surgeon who can hold up a conversation with a patient for more than 5 minutes.

 

[deleted314957]

Cool story!


Most attendings were very supportive of my interest in path, and I was always very open with them about it, but I still tried to learn and work hard on whatever service I was on.

One surgeon said: "A good pathologist who doesn't hedge is worth his weight in gold." I took it as a complement but I noted the not so subtle comment couched in the middle!

That comment "couched in the middle" can be critical to your success as a hospital staff pathologist. I had a surgeon call me after my return from vacation asking me to review a case that my"coverage" signed out. The surgeon said he was going to have to operate on my "coverage" to remove the pole from his ass, as he had been sitting on the fence for so long. Certainly not the kind of comment you want associated with yourself.>

 

[zao275]

An accurate pathologist who doesn't hedge might be worth their weight in something nice. But confidently being wrong is, I daresay, much worse. But absolutely, being prompt, accurate, and definitive -- especially with surgeons -- will certainly help with marketing and the grapevine.

Did any of you attend the evening Soft Tissue Subspecialty conference at USCAP? It was really great, and most of the speakers were quite entertaining. Kris Unni gave a very funny talk, but I was pretty shocked at one thing he said (I will paraphrase because I can't recall the exact words): Be right, or be wrong, but always be certain. Wow! I am sure he is a phenomenal pathologist, but I hope most of the audience does not take that bit of advice to heart. It seems to me that a healthy balance is wisest.

@mikesheree: Hahaha. Did you talk to your "coverage" and give some feedback, or did you just leave it alone? I agree with your point, though, that hedging too much is not helpful to anyone.

 

[2121115]

I think you'd all be surprised how many PATHOLOGISTS have misconceptions about pathology, let alone clinicians.

 

[Enkidu]

I think you'd all be surprised how many PATHOLOGISTS have misconceptions about pathology, let alone clinicians.

What do you mean by that, exactly?

 

[BrainPathology]

Did any of you attend the evening Soft Tissue Subspecialty conference at USCAP? It was really great, and most of the speakers were quite entertaining. Kris Unni gave a very funny talk, but I was pretty shocked at one thing he said (I will paraphrase because I can't recall the exact words): Be right, or be wrong, but always be certain. Wow! I am sure he is a phenomenal pathologist, but I hope most of the audience does not take that bit of advice to heart. It seems to me that a healthy balance is wisest.

If you don't reach a certain level of certainty in your cases you'll have a really hard time signing anything out. There will be times in anyone's career where they are SURE that something is a particular diagnosis and a molecular test, a subsequent resection, a legion of expert opinions or some other circumstance proves you wrong. I can't read his mind but similar sounding advice from other experts, when I asked for clarification from them, was explained in this way.

 

[zao275]

In the context of his talk, I inferred that he was saying something to this effect: "It doesn't matter if you are wrong as long as you make a confident diagnosis". In other words, be "bold but wrong" (as one of my surgery attendings used to say when I would try to guess the answer boldly during a pimping session). Maybe I interpreted incorrectly. I completely agree that you have to develop trust in your diagnostic ability, even though you know that you will most certainly miss some diagnoses, regardless of your skill.

 

[KCShaw]

I've heard similar used in a somewhat tongue-in-cheek manner, usually while referring to some Outside Brand-Name Pathology Department or Person. I've chosen to take away from it that one should be willing and able to defend their conclusions, rather than collapsing with uncertainty at the first question; alternatively put, be willing to accept the responsibility of your diagnosis and help the surgeon or other relevant/interested parties in being decisive in their own right. In some ways it's OK to ultimately be imperfect, if your opinion was initially still appropriately founded and in the setting of acceptable diligence. Some people just have difficulty with that degree of responsibility especially in the face of difficult questions or upset people.

I vaguely recall in residency some attendings discussing difficult biopsies with surgeons and simply saying words to the effect of, I'm not entirely sure what this is but I am sure it needs to come out. Instead of hanging the surgeon out in the breeze, they worked together to agree on a recommendation to the patient/family, even in the face of an "uncertain" definitive diagnosis.

There are ways to deal with this sort of thing, I think, without giving the impression of being an unhelpful waffler. I think it's particularly useful to find out what the current standard of care is for difficult differential diagnoses, because in the short term sometimes it effectively doesn't matter which of two or three different things something is because they're all treated identically, but you may not earn many friends by sitting on it or sending it out trying to subclassify it while everyone else just wants to know what to do today.

Do that enough and in those cases where you really don't know what to do with something you'll more likely have earned some cushion to work on it.

 

[Super Agar]

Usually our entire department of pathology and lab medicine is the butt of several jokes. Just the other week my Oncologist cousin was telling me how he'd like to help fund a Fecal Testing Lab that I would run alongside the other lab. scientists in the hospital. Then I told him how the entire hospital wouldn't last a second without a lab, and he walked away. It gets annoying, but that's the trend, I guess?

 

[twentyone]

In the context of his talk, I inferred that he was saying something to this effect: "It doesn't matter if you are wrong as long as you make a confident diagnosis". In other words, be "bold but wrong" (as one of my surgery attendings used to say when I would try to guess the answer boldly during a pimping session). Maybe I interpreted incorrectly. I completely agree that you have to develop trust in your diagnostic ability, even though you know that you will most certainly miss some diagnoses, regardless of your skill.

Favorite quote of a friend of mine: If you never make any diagnoses, you'll never make any mistakes."

 

[Enkidu]

Usually our entire department of pathology and lab medicine is the butt of several jokes. Just the other week my Oncologist cousin was telling me how he'd like to help fund a Fecal Testing Lab that I would run alongside the other lab. scientists in the hospital. Then I told him how the entire hospital wouldn't last a second without a lab, and he walked away. It gets annoying, but that's the trend, I guess?

Sounds like a douche. You'd think that an oncologist may be predisposed to see the value of pathology. More than any other field, they are completely dependent on a tissue diagnosis. That's why I think oncology sucks, it seems to be all about sharing emotional experiences with the patients while prescribing them chemotherapy that is almost never specific for their condition.

If that dude had made fun of me, I would have kicked him in the balls.

 

[Gene_]

Favorite quote of a friend of mine: If you never make any diagnoses, you'll never make any mistakes."

Another annoyance is seeing somebody generate a long list of histologic observations instead of a diagnosis.

 

[quepatho]

This conversation with yet *another* administrator at my school (different from the person I mentioned in another thread):

Admin: "What are you thinking of going into?"
Me: "I'm not entirely sure yet, but right now pathology looks interesting. Maybe third year will change my mind, but right now the plan is pathology."
Admin: /sputtering in confusion/ "But...you seem to have social skills..."
Me: /mentally/ And you looked like you weren't a jerk...

Grr.

 

[ScotchBonnet]

Another annoyance is seeing somebody generate a long list of histologic observations instead of a diagnosis.

So, you're saying you aren't a fan of derm path

 

[yaah]

This conversation with yet *another* administrator at my school (different from the person I mentioned in another thread):

Admin: "What are you thinking of going into?"
Me: "I'm not entirely sure yet, but right now pathology looks interesting. Maybe third year will change my mind, but right now the plan is pathology."
Admin: /sputtering in confusion/ "But...you seem to have social skills..."
Me: /mentally/ And you looked like you weren't a jerk...

Grr.

The correct reply to the admin's last statement is, "Why? Not having them didn't hurt you."

 

[Enkidu]

This conversation with yet *another* administrator at my school (different from the person I mentioned in another thread):

Admin: "What are you thinking of going into?"
Me: "I'm not entirely sure yet, but right now pathology looks interesting. Maybe third year will change my mind, but right now the plan is pathology."
Admin: /sputtering in confusion/ "But...you seem to have social skills..."
Me: /mentally/ And you looked like you weren't a jerk...

Grr.

Eh, I get this too. I may have good social skills, but I don't want to waste them on clinical medicine. Social skills are for social occasions, not for counseling complete strangers about their obesity.

In any case, I don't believe that anyone really likes that type of patient interaction, regardless of their level of social skills. I think it's a shared delusion of some kind. Given the chance, I believe that most physicians would prefer spending their time around other physicians rather than patients.

 

[KCShaw]

..snip..Social skills are for social occasions, not for counseling complete strangers about their obesity.

In any case, I don't believe that anyone really likes that type of patient interaction, regardless of their level of social skills. I think it's a shared delusion of some kind. ..snip..

I particularly like the shared delusion. But it's true..anyone can be taught how to not be TOO much of a bunghole, or learn how the average patient reacts to being told something and alter their approach accordingly. It's called medical school. Has anyone actually watched the average doctor/patient encounter and thought, hey, it would be cool to have a drink with that doctor and socialize some more..?

Some people are better at being empathetic than others, or at translating medical information quickly into layman's terms, fair enough, but being a pathologist trying to deal with clinicians who don't know what test they're really ordering -- much less what they're getting back? Social restraint might be a better term than social skillz sometimes.

 

[quepatho]

I'm sure there are many reasons that physicians choose to see patients but the one that I've seen OVERWHELMINGLY at my particular school (for whatever reason) is this sort of God-complex along the lines of "I WILL BESTOW UPON YOU [the patient] THE GREATNESS OF MY WISDOM, O IGNORANT ONE."

I personally want no part of that. I hope someone brings me down a notch if I *ever* get to be that much of a jerk towards another human being.

(It could very well be the particular location I've ended up in for school, but who knows.)

 

[Neuropathologist]

I have had at least 5 clinicians ask me "You don't have an electron microscope!! How do you do the reporting?" "What even the private labs do not have an electron microscope?"
The best comment by far was "Why do you need the history? If I give you history you will know the diagnosis and give correct report."
What??? Did he want the report or he was testing me?

 

[longlakeboy]

The clinicians I can't take are the ones who think sitting at a weekly tumor board means they have any idea what they're talking about.

As a resident, there was one doc who was certain anything with small round cells was lymphoma. Every. Friggin. Time.

When I didn't have attending backup at tumor board, I would just tell him I'd order a CD45 to shut him up.