Emergency Medicine and Pathology

[vtucci]

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I was wondering if anyone has double-boarded in emergency medicine and pathology. I know it may seem a strange combo- it just seems to me that path and EM are the two best fields for docs interested in figuring out the diagnosis and being very hands on. I love problem-solving. I had been planning on doing EM and then a fellowship in clinical forensics but thought I would ask you guys.

I have heard the stereotype that pathologists are typically stiff (pun intended) and have very limited patient interaction. However, our pathology faculty at USF are amazing and extremely outgoing and personable. Are these extroverts the exception? They love teaching and make the subject so fascinating. One of the attendings was really trying to sell me on the field the other day and I figured I would ask you guys about it.

I will admit that the idea of being in lab does not appeal to me at all (in large part because formalin triggers my allergies) which is why I was wondering if they could be combined. I thought that perhaps if you were double-boarded in path and EM that it would make you a better doc in both areas?

 

[deleted113029]

I was wondering if anyone has double-boarded in emergency medicine and pathology. I know it may seem a strange combo- it just seems to me that path and EM are the two best fields for docs interested in figuring out the diagnosis and being very hands on. I love problem-solving. I had been planning on doing EM and then a fellowship in clinical forensics but thought I would ask you guys.

I have heard the stereotype that pathologists are typically stiff (pun intended) and have very limited patient interaction. However, our pathology faculty at USF are amazing and extremely outgoing and personable. Are these extroverts the exception? They love teaching and make the subject so fascinating. One of the attendings was really trying to sell me on the field the other day and I figured I would ask you guys about it.

I will admit that the idea of being in lab does not appeal to me at all (in large part because formalin triggers my allergies) which is why I was wondering if they could be combined. I thought that perhaps if you were double-boarded in path and EM that it would make you a better doc in both areas?

those 'extroverts' are not the exception. most pathologists i have encountered have been pleasant to be around. I am so glad I chose pathology.

as far as the formalin goes, just go to your allergist and have him inject increasing amounts of formalin to achieve desensitization. 🙂 (or wear gloves)

 

[LADoc00]

I was wondering if anyone has double-boarded in emergency medicine and pathology. I know it may seem a strange combo- it just seems to me that path and EM are the two best fields for docs interested in figuring out the diagnosis and being very hands on. I love problem-solving. I had been planning on doing EM and then a fellowship in clinical forensics but thought I would ask you guys.

I have heard the stereotype that pathologists are typically stiff (pun intended) and have very limited patient interaction. However, our pathology faculty at USF are amazing and extremely outgoing and personable. Are these extroverts the exception? They love teaching and make the subject so fascinating. One of the attendings was really trying to sell me on the field the other day and I figured I would ask you guys about it.

I will admit that the idea of being in lab does not appeal to me at all (in large part because formalin triggers my allergies) which is why I was wondering if they could be combined. I thought that perhaps if you were double-boarded in path and EM that it would make you a better doc in both areas?

Funny, I do actually know a prominent pathologist who is boarded in EM and Pathology.

The reality is you will need to decide what you will practice either Path or EM. In a practical sense you cannot do both.

Maybe as a second career, path or EM is an option. I would take a very careful look before deciding. Limited impressions based on med school faculty is a bad idea IMO.

 

[b&ierstiefel]

I'm sorry...but



Let me guess...you've been watching too much "House" on TV. Sorry, it doesn't work that way in the real world.

You're certainly right...there is limited patient interaction in pathology which is quite opposite of the situation in EM. Honestly, I like that. I used to think that I miss patient interaction...I don't.

Oh, BTW...just because we don't interact with patients don't mean we're socially ******ed. Patient interactions are contrived interactions where we don't act like our natural selves...it's called professionalism. OK? Pathologists have lives outside of work and we don't live in basements when we're not at work.

 

[yaah]

I was wondering if anyone has double-boarded in emergency medicine and pathology. I know it may seem a strange combo- it just seems to me that path and EM are the two best fields for docs interested in figuring out the diagnosis and being very hands on. I love problem-solving. I had been planning on doing EM and then a fellowship in clinical forensics but thought I would ask you guys.

I have heard the stereotype that pathologists are typically stiff (pun intended) and have very limited patient interaction. However, our pathology faculty at USF are amazing and extremely outgoing and personable. Are these extroverts the exception? They love teaching and make the subject so fascinating. One of the attendings was really trying to sell me on the field the other day and I figured I would ask you guys about it.

I will admit that the idea of being in lab does not appeal to me at all (in large part because formalin triggers my allergies) which is why I was wondering if they could be combined. I thought that perhaps if you were double-boarded in path and EM that it would make you a better doc in both areas?

Like Andy, my response is sort of 😕

Why on earth would you double board? Are you planning to work M-F as a pathologist and then moonlight on the weekends in an ER? Because you could probably do a general medical or surgical internship and moonlight on weekends in an urgent care clinic or something. It just makes no sense to do two residencies when you will never combine the two. Will doing an ER residency make you a better forensic pathologist? No it will not. Just like doing a surgical residency doesn't necessarily make you a better surgical pathologist - it might help you understand some things from a different perspective, but that's it. You can also gain a lot of this understanding by being a competent physician and a good communicator. It's kind of pointless to do another 3-4 years of training just to get a different perspective that ultimately means very little.

I get the sense a lot of people think of medicine like college - the so-called "double major" will make me more competitive. No, it doesn't. It makes you unique but it also makes you look weird. You get all the training you need within the field you train in to adequately do your job. Electives exist so that you can explore other things in different detail. The only people who are really double boarded are those who tried one thing and didn't like it, or those who really can't make up their mind, or those who are trying to create some kind of niche ubermensch-physician that isn't needed.

Having a formalin allergy would be tough. We have one attending who does, and if he has to be around formalin he has to put a respirator on.

 

[mcfaddens]

I'm sorry...but



Let me guess...you've been watching too much "House" on TV. Sorry, it doesn't work that way in the real world.

You're certainly right...there is limited patient interaction in pathology which is quite opposite of the situation in EM. Honestly, I like that. I used to think that I miss patient interaction...I don't.

Oh, BTW...just because we don't interact with patients don't mean we're socially ******ed. Patient interactions are contrived interactions where we don't act like our natural selves...it's called professionalism. OK? Pathologists have lives outside of work and we don't live in basements when we're not at work.

Hey! Whats wrong with Living in a basement!

 

[vtucci]

I will grant you that House is an amusing show but as removed from reality as any other medical show be it ER, CSI or Quincy (for those of us who can still remember that show).

I enjoy forensics that is why it was a thought. However, with my allergies exacerbated by formalin (of course we were gloves- it is respiratory allergies that are the problem) and my preference for dealing with patients and interpersonal interaction, I will likely stick to an emergency medicine residency with the clinical forensics fellowship.

I don't think anyone should make up their mind based on one professor, one rotation etc and we should all get as much information as possible before committing to one field or another. That is why I thought I would ask.

Good luck to you all.

 

[Prairie]

What exactly is clinical forensics? I'm only aware of forensic psych and forensic path.

 

[yaah]

I will grant you that House is an amusing show but as removed from reality as any other medical show be it ER, CSI or Quincy (for those of us who can still remember that show).

I watched one episode of house, and it completely turned me off because of the following sequence of events.

1) Patient is sick with some weird disease defying diagnosis.
2) House demands a lung biopsy which everyone agrees to after hemming and hawing. But who performs the lung biopsy? His residents (aren't they neurologists or something?)
3) They do the lung biopsy, and one of the residents takes the lung wedge OVER TO A MICROSCOPE in the corner of the OR.
4) Resident puts the piece of lung under the scope (mind you, without doing anything to it except putting it on the scope - no freezing, no cutting, no anything). Says it "looks normal."
5) House says, "How about a congo red?"
6) Resident says, "Wow, you think he might have Amyloidosis?" Then takes a small container from the shelf, and puts a drop of red solution onto the piece of lung.
7) Resident looks at it (along with the television audience) and it lights up green. (Apple green, of course). Voila. The diagnosis is made.

If I need to tell you what is wrong with the above sequence of events, it's basically everything. Because the only ones that have any real relevance are #1 and #5, and they are just statements.

I don't know what clinical forensics is. Maybe toxicology? Legal issues related to the practice of emergency medicine such as identifying evidence? I dunno.

 

[Circumflex]

When we did our pediatrics rotation, we were required to go to "Forensics Clinic" a couple of times. Apparently, after a pediatrics residency, you can do a 2-year fellowship in clinical forensics. In clinic, we saw kids who were abused (mostly sexually) or who were suspected of being abused. Kids were referred by the ER, private practitioners, or law enforcement. The attendings were in court a lot.

I guess that there is a similar fellowship for adults (domestic abuse, rape) - don't know if there is board certification.

 

[pathdawg]

I watched one episode of house, and it completely turned me off because of the following sequence of events.

1) Patient is sick with some weird disease defying diagnosis.
2) House demands a lung biopsy which everyone agrees to after hemming and hawing. But who performs the lung biopsy? His residents (aren't they neurologists or something?)
3) They do the lung biopsy, and one of the residents takes the lung wedge OVER TO A MICROSCOPE in the corner of the OR.
4) Resident puts the piece of lung under the scope (mind you, without doing anything to it except putting it on the scope - no freezing, no cutting, no anything). Says it "looks normal."
5) House says, "How about a congo red?"
6) Resident says, "Wow, you think he might have Amyloidosis?" Then takes a small container from the shelf, and puts a drop of red solution onto the piece of lung.
7) Resident looks at it (along with the television audience) and it lights up green. (Apple green, of course). Voila. The diagnosis is made.

This would be the actual sequence if "House" were a reality show:

1. Patient is sick woth some weird disease
2. Patient is admitted.
3. After putzing around for a few days with unnecessary and redundant lab tests, they still don't know what disease the patient has.
4. They consult a surgeon who decides to cut it out (without any particular differential diagnosis in mind).
5. They order a frozen section.
6. Pathologist gets a wedge of lung tissue without a discrenable tumor.
7. Pathologist calls surgeon and asks "What are you looking for?"
8. Surgeon is already out of the OR and in his BMW in the parking lot. However, the surgery resident replies, "Not sure. This guy's gor some weird lung disease."
9. Pathologist does frozen section anyway (hey, might as well bill for this waste of time).
10. Pathologist looks at permanent sections next day and sees some waxy material around vessels. Orders congo red.
11. Next day, pathologist receives congo red stain, but the control doesn't work. Reorders congo red.
12. Following day, again receives stain, polarizes it, and voila, apple-green birefringence.
13. Pathologist calls surgeon and tells him that the diagnosis is amyloidosis.
14. Surgeon does not remember which patient you are talking about.
15. Surgeon, upon reviewing the chart, then says that was what he suspected all along.

Thats reality, my friends. Think this episode would work during sweeps?

 

[b&ierstiefel]

This would be the actual sequence if "House" were a reality show:

1. Patient is sick woth some weird disease
2. Patient is admitted.
3. After putzing around for a few days with unnecessary and redundat lab tests, they still don't know what disease the patient has.
4. They consult a surgeon who decides to cut it out (without any particular differential diagnosis in mind).
5. They order a frozen section.
6. Pathologist gets a wedge of lung tissue without a discrenable tumor.
7. Pathologist calls surgeon and asks "What are you looking for?"
8. Surgeon is already out of the OR and in his BMW in the parking lot. However, the surgery resident replies, "Not sure. This guy's gor some weird lung disease."
9. Pathologist does frozen section anyway (hey, might as well bill for this waste of time).
10. Pathologist looks at permanent sections next day and sees some waxy material around vessels. Orders congo red.
11. Next day, pathologist receives congo red stain, but the control doesn't work. Reorders congo red.
12. Following day, again receives stain, polarizes it, and voila, apple-green birefringence.
13. Pathologist calls surgeon and tells him that the diagnosis is amyloidosis.
14. Surgeon does not remember which patient you are talking about.
15. Surgeon, upon reviewing the chart, then says that was what he suspected all along.

Thats reality, my friends. Think this episode would work during sweeps?

You forgot the part where clinicians page you asking what the preliminary read is as the congo red is being ordered...and again when the congo red is being repeated.

Nice post though...I laughed my ass off

 

[Apollyon]

What exactly is clinical forensics? I'm only aware of forensic psych and forensic path.

One definition of 'forensic' means dealing with courts and law. You've hit two of them - psych and path. 'Clinical forensics' includes rape/sexual assault exams and crime scene/evidence collection.

Duke has a peds fellowship called "Child Abuse and Neglect". It ain't pretty, and my heart goes out to the docs and staff in that program.

 

[dkpwalker]

I was wondering if anyone has double-boarded in emergency medicine and pathology. I know it may seem a strange combo- it just seems to me that path and EM are the two best fields for docs interested in figuring out the diagnosis and being very hands on. I love problem-solving. I had been planning on doing EM and then a fellowship in clinical forensics but thought I would ask you guys.

I have heard the stereotype that pathologists are typically stiff (pun intended) and have very limited patient interaction. However, our pathology faculty at USF are amazing and extremely outgoing and personable. Are these extroverts the exception? They love teaching and make the subject so fascinating. One of the attendings was really trying to sell me on the field the other day and I figured I would ask you guys about it.

I will admit that the idea of being in lab does not appeal to me at all (in large part because formalin triggers my allergies) which is why I was wondering if they could be combined. I thought that perhaps if you were double-boarded in path and EM that it would make you a better doc in both areas?

I applied to both specialities, 42 EM, 32 Pathology and not one interview yet, doubt i will ever get any, i guess my scores were not competitive enough, 78, 99, pass, ecfmg certified.

 

[deleted113029]

I applied to both specialities, 42 EM, 32 Pathology and not one interview yet, doubt i will ever get any, i guess my scores were not competitive enough, 78, 99, pass, ecfmg certified.

your step 1 of 78 is most likely the culprit in your application. most require an 80 or even an 85.

 

[djmd]

your step 1 of 78 is most likely the culprit in your application. most require an 80 or even an 85.

While the scores might be it.
Letters of recommendation that don't say if you are going to be a great _blank_, are bad, and unless you have to separate sets of letters, yours don't say anything about being well suited for Path or EM.

 

[dkpwalker]

While the scores might be it.
Letters of recommendation that don't say if you are going to be a great _blank_, are bad, and unless you have to separate sets of letters, yours don't say anything about being well suited for Path or EM.

i had separate LOR's and separate personal statements, the works, just wasted all my money for nothing. felt badly initially but have now gotten over it, now preparing for step3.🙁

 

[Psychopathology]

11. Next day, pathologist receives congo red stain, but the control doesn't work. Reorders congo red.

almost died laughing

 

[LADoc00]

almost died laughing

would be hilarious if that didnt happen so often to me.

 

[Boopieness]

I do not (for the most part) enjoy patient contact. I can learn from the scope and see so much more in a day by reading and scanning someone else's H&P and not have to sit through grandma's recollection of her meds. It was a pink pill,no wait it was red. (Or non-compliance issues, but they continue to see you.)

I was a Gulf War I combat medic and felt the pull of ER medicine. But I fell l in love with Pathology in medical school. So, I got around that. I am in a path r(my first love) residency but am in the National Guard, nondeployable during residency (I got out of Iraq, I am truly non-deployable in residency).

I am a Captain and still serve the patient population I intended to. I perform physicals and use what I learned in med school on two week annual humanitarian missions abroad with the military and 1 weekend a month. While I will never be ER formally trained. I get to work with other residents in other disciplines and hear them whine about how hard their residency is. I also work with seasoned professionals who are there for consultation when I feel something is beyond my training. They know that I am in Pathology. I have also been trained to take charge in setting up "LEGO" hospital that can be set up in the middle of nowhere with state of the art mobile equipment, set up triage, med evac in field environments, preventive medicine, Infectious disease and work under nuclear biological and chemical conditions and manage a field hospital.

The military can use any doc they can get and I get the honor to serve the patient population that doesn't whine and takes their meds when a physician advises it's in their best interest.

I will only be deployed 90 days out of the year when I do graduate, if I choose not to resign my commission during residency. I get to indulge my wild side and still wear the uniform in the reserve. I do what I am comfortable with. I have limited my privileges to what I know. If/when I am deployed I can assist the surgeon, work with the ER docs and or hit the ward with the basics to free up the docs who just need a break.

Or I can pursue becoming a flight surgeon (fancy name for GP for pilots, and go up with them. It is a 6 week basic course in aerospace medicine. And I can use it as an elective with my residency directors permission.) I get my wings when I complete residency.

Pathology, even in residency, allows one to indulge other interests.

I am not recruiting. I wouldn't send advise anyone to do what I have done or go to war. But I've been there, I know what I am getting myself into with my eyes wide open. It fulfills my needs and I get to see more then a microscope.