defending an interest in pathology

[spaceman_spiff]

As an ms3 going through the clerkships it seems like residents and attendings (and of course classmates) are all asking, "so what field are you interested in?" and my answer would be a vague "not sure yet..." because, honestly, it's early in the 3rd year and alot could change, and plus I'm a little afraid that someone might discourage me from going into the field I'm meant to be in.

But sometimes a couple of these people have been persistent and I can only BS them for so long and so I spout off a few specialties that I'm interested in, path included, and I get the follow-up "why pathology?" along with their take of who goes into path and the state of path now (all coming from non-pathologists, mind you).

it seems that what a couple people have said is, "great lifestyle" and "you're gonna have a life," and similar comments like that which bother me because it implies that that's a big reason or even the most important reason for doing it. I say, if you're shoveling poop everyday and get off work at 4 pm, who cares, you're still shoveling poop. you gotta love what you do before you make it a career, and I want my interest in the field to be the biggest factor, not lifestyle. Another thing they say, after I tell them I had a really great autopsy experience in 2nd year, is some comment about how no one is paying for autopsies anymore, and that the role of the autopsy is really decreasing, and this and that negative story about autopsy. this comment doesn't bother me too much since it seems forensics is an option for doing autopsies if that appeals to me. And the third thing that some have said is that the people who did well in first 2 years of med school are the ones who do path because path is basically a continuation of the 1st 2 years... and I don't know enough about pathology as a residency to answer that. i'm not even close to the top of my class for the basic science years ... should this even be a factor in whether i would do well in pathology? i do know that i liked the course in 2nd year and had a great time in my autopsy experience. i really really like that it's a very visual field and had fun in histo lab. haven't done a rotation in path (yet).

why they like to pick on pathology i don't know. What I would like to know is if...
1) what they claim about path is true
2) if my reasons for liking it are enough. you probably won't change my mind if they aren't but maybe if they would be good enough for someone to think about as a career... any thoughts would be helpful.

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[yaah]

I would be very cautious about the validity of non-pathologists making statements on the field and the people in it. The majority of clinicians are only slightly above the patient level of understanding when it comes to knowing what a pathologist does.

Personally, I think you have the right idea about the lifestyle comments - lifestyle is all well and good but doesn't mean squat if you don't like what you're doing or aren't interested.

The other thing is that autopsy is a different part of pathology - many pathologists have little or no autopsy responsibilities once they finish residency. I would try to get some exposure to pathology early in 4th year to see what the other parts are like. You can also meet with someone this year.

I wouldn't worry a ton about the basic science class stuff. Real life stuff comes from a bit of a different perspective. Path is not a continuation of 1st and second year. There are perhaps more real world applications but all of medical school is important for understanding.

 

[KeratinPearls]

As an ms3 going through the clerkships it seems like residents and attendings (and of course classmates) are all asking, "so what field are you interested in?" and my answer would be a vague "not sure yet..." because, honestly, it's early in the 3rd year and alot could change, and plus I'm a little afraid that someone might discourage me from going into the field I'm meant to be in.

But sometimes a couple of these people have been persistent and I can only BS them for so long and so I spout off a few specialties that I'm interested in, path included, and I get the follow-up "why pathology?" along with their take of who goes into path and the state of path now (all coming from non-pathologists, mind you).

it seems that what a couple people have said is, "great lifestyle" and "you're gonna have a life," and similar comments like that which bother me because it implies that that's a big reason or even the most important reason for doing it. I say, if you're shoveling poop everyday and get off work at 4 pm, who cares, you're still shoveling poop. you gotta love what you do before you make it a career, and I want my interest in the field to be the biggest factor, not lifestyle. Another thing they say, after I tell them I had a really great autopsy experience in 2nd year, is some comment about how no one is paying for autopsies anymore, and that the role of the autopsy is really decreasing, and this and that negative story about autopsy. this comment doesn't bother me too much since it seems forensics is an option for doing autopsies if that appeals to me. And the third thing that some have said is that the people who did well in first 2 years of med school are the ones who do path because path is basically a continuation of the 1st 2 years... and I don't know enough about pathology as a residency to answer that. i'm not even close to the top of my class for the basic science years ... should this even be a factor in whether i would do well in pathology? i do know that i liked the course in 2nd year and had a great time in my autopsy experience. i really really like that it's a very visual field and had fun in histo lab. haven't done a rotation in path (yet).

why they like to pick on pathology i don't know. What I would like to know is if...
1) what they claim about path is true
2) if my reasons for liking it are enough. you probably won't change my mind if they aren't but maybe if they would be good enough for someone to think about as a career... any thoughts would be helpful.

I seriously can't understand why ppl are so caught up in how others perceive what they would be doing for a living for the rest of your life. Do what interests you the most. If it's pathology, then be it.

I see a lot of posters who comment on how pathology is perceived by others in the medical community. Who really cares? Do what you like and be good at it for the sake of your patients.

If I had attendings make comments about my field, I could care less. I know I would not like doing anything other than path. If I did anything else, I prob would suck b@lls at it.

 

[HESC]

I found that I told the attendings/resident/ other med student something that they didn't know about pathology they would change their tune real quick.

For instance tell them that GE (the same company that digitized Radiology) is digitizing pathology and that by the time you finish residency you probably wont have to look through a scope all day long, or tell them that molecular pathology is one the the fastest growing and most profitable area's in medicine....

this kind of info should make them think that you really know what your getting into.

cheers...

 

[Psychopathology]

What I would like to know is if...

1) what they claim about path is true
2) if my reasons for liking it are enough. you probably won't change my mind if they aren't but maybe if they would be good enough for someone to think about as a career... any thoughts would be helpful.

1. I've received a broad range of reactions from people when I tell them that I am going to (hopefully) become a pathologist. Everyone has preconceived notions about how doctors in other fields spend their days. There seems to be more speculation than facts floating around medical school classes about pathology, radiology, dermatology, and other fields that are not incorporated into the third year curriculum.

Here is one of the popular reactions that I get from non-pathologists:

"Great lifestyle. I totally feel you, you know? The lifestyle, man. Great hours. Lots of money. You won't have to work very hard."

Coming from a senior surgery resident who hasn't seen his kids in a couple of nights, it's difficult to argue. But I know what it feels like to be showered with late afternoon specimens and handed a stack of cases that need to be previewed before the morning sign out. I also understand that the programs I have applied to are going to have mighty high expectations and demand much of my next four years. I probably will not miss lunch very often. I probably will not miss dinner very often. I will make it to the gym before it closes even if that requires me to return to work afterwards. I will sleep much more than I slept on some of my third year clerkships. I will have most of my weekend free from work on a slight majority of rotations. I will be able to sleep during call most of the time. I will also work at a comfortable pace in an atmosphere far less insane than the wards, the emergency room, or the clinic.... but there will be pressure to develop encyclopedic knowledge and a good eye, to be proficient and professional. I will spend a chunk of time reading outside of work and making dramatic efforts to establish confidence with diagnosis and with answering consults in just four years. That's a tall order. That's not a 9 to 5. But it's a very different sort of environment than internal medicine or surgery, I find pathology more interesting than anything else that I have encountered, and I'm going to feel more comfortable at work because of that. So, I guess pathology encompasses the sort of lifestyle that compliments my personality and habits... but someone who does not want to become a pathologist might react quite differently to the culture, even if they work 65 hours a week instead of 83.

Really, how many residents watch the clock at work?

You leave when the job's finished.



2. I wouldn't have picked pathology if I hadn't thoroughly investigated it as a potential career. Do rotations as early as possible. Surgical pathology is a must. Transfusion medicine may be a solid rotation depending on your institution if you are considering clinical pathology. Rotate through some of the other services such as hematopathology, autopsy, and cytology. Some programs allow students to be creative with scheduling. There are a lot of subspecialties and career pathways in our field. Investigate them! Second year pathology class doesn't cut it.

Also, let me join the others in dismissing the myth that pathology is a continuation of first and second years of medical school. I enjoyed my pathology course but only began to really understand and appreciate all of the basic sciences in the context of learning pathology. I had a rough time adjusting to a basic science curriculum and only started to shine during clerkships. I've been told over and over again that a great asset for a pathologist is being able to think like a clinician and anticipate their needs. The field thrives on communication in as much as it thrives on differential diagnoses, appreciation for disease mechanisms, and pattern recognition. These develop during residency. We don't have a transition year or internship, so with respect to accumulating bedside and clinical knowledge... third year is it. You're allowed to be less than stellar at biochemistry and still get interviews at great programs!


Hope this helps.

 

[DrMeditrina]

As a med student I haven't encountered the same attitude, of having to defend my interest in pathology....

I like the study of disease more so than treating disease

It has a greater focuses on science, and I think lots of physicians loose that focus as clinicians

It gives you a great understanding of disease mechanism, which many physicians actually lack

It's a key role at the diagnosis level....huge responsibiltiy b/c attached to each slide is an actual patient, and consequenses of missing a diagnosis are huge--that role appeals to me

Those are my general reasons.

 

[Hurricane95]

Path is a damn important specialty, although often overlooked. How many times do specialists biopsy something and send it off to them for Dx? Or how often do surgeons cut out a specimen that no one knows what the hell it is and needs their wisdom in ID'ing it? Who REALLY makes the cancer diagnosis? It's all pathology man. They and radiology are the doctor's doctors if you know what I'm saying.

Don't be embarrassed or insecure about telling someone you want to do path. It's a cool field that not that many people can really be great at. It's tough and requires lots of expertise and a huge knowledge base. I would suck terribly at it and could never do it, but remember there are many great reasons for wanting to go into this field.

 

[Napoleon1801]

As an ms3 going through the clerkships it seems like residents and attendings (and of course classmates) are all asking, "so what field are you interested in?" and my answer would be a vague "not sure yet..." because, honestly, it's early in the 3rd year and alot could change, and plus I'm a little afraid that someone might discourage me from going into the field I'm meant to be in.

But sometimes a couple of these people have been persistent and I can only BS them for so long and so I spout off a few specialties that I'm interested in, path included, and I get the follow-up "why pathology?" along with their take of who goes into path and the state of path now (all coming from non-pathologists, mind you).

it seems that what a couple people have said is, "great lifestyle" and "you're gonna have a life," and similar comments like that which bother me because it implies that that's a big reason or even the most important reason for doing it. I say, if you're shoveling poop everyday and get off work at 4 pm, who cares, you're still shoveling poop. you gotta love what you do before you make it a career, and I want my interest in the field to be the biggest factor, not lifestyle. Another thing they say, after I tell them I had a really great autopsy experience in 2nd year, is some comment about how no one is paying for autopsies anymore, and that the role of the autopsy is really decreasing, and this and that negative story about autopsy. this comment doesn't bother me too much since it seems forensics is an option for doing autopsies if that appeals to me. And the third thing that some have said is that the people who did well in first 2 years of med school are the ones who do path because path is basically a continuation of the 1st 2 years... and I don't know enough about pathology as a residency to answer that. i'm not even close to the top of my class for the basic science years ... should this even be a factor in whether i would do well in pathology? i do know that i liked the course in 2nd year and had a great time in my autopsy experience. i really really like that it's a very visual field and had fun in histo lab. haven't done a rotation in path (yet).

why they like to pick on pathology i don't know. What I would like to know is if...
1) what they claim about path is true
2) if my reasons for liking it are enough. you probably won't change my mind if they aren't but maybe if they would be good enough for someone to think about as a career... any thoughts would be helpful.

My advice would be to not to consider others' opinions in choosing your career. You love it because you love it. Waiting until fourth year is really too late if you already know that you have a thing for pathology. Jump in and do a research poster with a faculty member in the path department. Send an email to the pd or chair and ask who's looking for someone to help them with projects sitting around. Use your cush rotations to work on it. Find something that's doable in your spare time and make yourself a known quantity in the path department. Get a path mentor. Get some time to sit and talk with a path resident. I've been to 3 different places for aways and I have not met a pathology resident that doesn't have you call them by their first name. Path residents are personable, get to know them one way or another.

Don't talk to other people about pathology. Change the conversation and talk about something else, like why they went into medicine. Most people just don't understand why you're so abnormal that you would ever do pathology. Usually "I don't know" or "ummm....internal medicine" keeps people from classifying you in third year. Not everyone respects pathology and it could impact your grade. I would play the game like everyone else.

 

[spaceman_spiff]

wow, well thank you all for your replies. i appreciate the encouragement to not pay too much attention to some of those people, but it's still hard to know what is going to be the best fit for me. Some attendings have actually said very positive things to me, like "You think like a ______(insert whatever field here)" or "you would make a good _____", which I take to be complementary, and also which makes me really consider maybe why they say that and then I think yeah, maybe I would make a good _____. it's harder to disregard a positive comment. but anyways. thanks, I am off to spend some time in the path department.