Good for a laugh ;)

[icpshootyz]

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http://www.xtranormal.com/watch/6847761/

 

[gschl1234]

Funny video. Has anyone ever heard a pathologist actually do this though? We seem to pretty much do whatever is ordered without discussion. One resident in my program once asked a surgeon whether we can call up the rapid gross she ordered on a colon rather than running it back up and she still made him run it up, although she admitted there was no difference in management plan.

 

[pathstudent]

Funny video. Has anyone ever heard a pathologist actually do this though? We seem to pretty much do whatever is ordered without discussion. One resident in my program once asked a surgeon whether we can call up the rapid gross she ordered on a colon rather than running it back up and she still made him run it up, although she admitted there was no difference in management plan.

It was sort of funny. I liked the part where the surgeon withheld that the patient had colon cancer.


What do you mean made him run it up? Do you mean deliver the findings face to face versus over the phone?

 

[caffeinegirl]

Some other funny pathology related things...

"I'm a pathologist"
http://www.youtube.com/watch?v=H4-mo10GbEo
lyrics: http://www.metrolyrics.com/im-a-pathologist-lyrics-haemorrhage.html

And of course the classic
"Pathology" the movie
http://www.youtube.com/watch?v=E_9NGVf2ZqE

Aaahhh...love wasting time before my boards tomorrow!
🙂

 

[KCShaw]

I'm not familiar with the term "rapid gross" per se -- we used to do a partial gross on certain specimens in the frozen room somewhat regularly, and decide in conjunction with the surgeon whether a frozen was warranted. Mainly the surgeons wanted an idea whether they had decent gross margins on some difficult to palpate tumor, and only sometimes felt microscopic frozen margins would change immediate management. Either way, I never ran to, from, or for anything as a pathology resident. If it can't wait for a pathology resident, please hang up and dial 911. Usually the fastest I would move is if one of our impatient attendings was on service and in the frozen room, as there was always the risk they would start and turn the room into a mess before I got there.

We used to regularly question surgeons (surgical residents and fellows moreso than attendings, because attendings were either 1. making better decisions in the first place, or 2. were so set in their ways and had already had enough arguments with the path attendings that we weren't getting anywhere) regarding whether they would use the results for immediate intra-operative care decisions. And we would...educate them when we found out the patient had already left the OR when we called back with the result. For the most part, the surgical department chairs would help educate and back us up.

I don't recall surgeons intentionally withholding something relevant for a frozen, but it happened some with regular specimens -- often using exactly the same phrase, "I didn't want to bias you.." or some vaguely veiled poke at our ability to know what something is without being "told" by clinical history.

 

[gschl1234]

At our institution rapid grosses are routinely done on colons even when the tumor is far from each margin (like >15 cm) and was grossly palpable from the outside. The surgeons mostly like to look at their work, or so we are told. Rapid grosses/frozens are done for all whipples which are then run up to the ORs for surgeon viewing. Rapid grosses/frozens are done for cystectomies but don't have to be run up to the surgeon, just frozen results called up. Same with lungs. Livers with mets are always run up but not necessarily frozen depending on gross. I guess it's all institutionally/surgeon dependent. I've never seen a surgeon questioned about whether or not the frozen was necessary. The closest I've ever heard was about the rapid gross colon. I guess the only problem with the questionable frozen/rapid gross is that it takes time away from legitimate requests which is especially a problem when different cases are requested simultaneously.

 

[2121115]

As long as it is not in the middle of the night, if a surgeon requests a frozen I say just do them. You can bill for it and as long as you are there anyway doing other frozens what is the big deal? There is no downside. If you have to come in during the middle of the night that is different story.

 

[KCShaw]

Among the downsides is when a surgeon takes a frozen result and treats it like a final. In residency there were several occasions when it became apparent a surgeon had instituted further therapy based on a frozen result when the final result would have indicated different treatment. This isn't always something major, triggering an obligatory phone call when reading the final, but may affect management nonetheless -- especially if the pathologist isn't provided adequate clinical history to begin with.

Another downside is when inadequate sample is sent to begin with, and you freeze it, making the final result less ideal. We used to see this commonly with brain biopsies; fortunately those surgeons were more acutely aware of the problem, and generally maintained a pretty good line of communication with the neuropathologists.

Additionally, some/many/?most pathologists regularly performing frozen sections are working on salary -- not being paid by what they bill.

IMO, in general, while sometimes interesting and having their place in appropriate circumstances, frozen sections are like most other screens -- of limited value only in specific circumstances, and when taken out of their useful context are otherwise both a waste of resources and a risk to patient outcome.

 

[Sean2tall]

Rapid grosses/frozens are done for cystectomies but don't have to be run up to the surgeon, just frozen results called up.

What kind of rapid gross can be done for a cystectomy? The only thing I have ever encountered is assessing the ureter margins by frozen section (although truth be told I think the literature suggests that routine frozen section for ureter margins is not necessary). They are just curious to see the tumor?

 

[deleted314957]

Funny video. Has anyone ever heard a pathologist actually do this though? We seem to pretty much do whatever is ordered without discussion. One resident in my program once asked a surgeon whether we can call up the rapid gross she ordered on a colon rather than running it back up and she still made him run it up, although she admitted there was no difference in management plan.

i have refused to do a frozen many times, always for a good reason. However I have been the lab director/pathologists at the same hospital for more than 20 years and i have some cred with the medical staff, especially the surgeons.

 

[zao275]

Our hospital has a very busy urology service, with almost daily nephrectomies for tumor. Most urologists ask us to bisect/bivalve the kidney, make a gross diagnosis (ie- RCC vs urothelial carcinoma), and then take the specimen to the OR to show them (we call it "show and tell"). Our frozen lab is next to the OR, so this is not a major difficulty. I actually really like doing this and I feel the interactions with the surgeons and urologists helps build rapport (and is part of the idea of being transformational that CAP is promoting). In fact, I think the more face to face time a pathologist spends with a surgeon, the more credibility he/she will get, which may make it easier for the pathologist to say to the surgeon: "Look, Jack, I know you want what is best for your patient. I just don't think a frozen is in the best interest of your patient in this case."

 

[KCShaw]

There is a fine line between utility, politics, and miscommunicating an "impression" as a "diagnosis."

I think if a program/practice has the time and facility to regularly run around for show & tell, there is certainly benefit to the simple interaction with surgeons and appearing more involved. Personally I would rather a surgeon come to the gross room at the conclusion of surgery, if it's not going to change anything during the course of surgery -- since that's what the gross room is for. Then again I have little patience for the impatience of some surgeons, such as those who don't want to wait until the end of surgery, don't want to wait for a photo, don't want to have to make a phone call, don't want to wait for an actual final report, etc.

 

[yaah]

They need to do one of those with the pathologist and the orthopedic surgeon asking for neutrophil counts. Especially when they send you a chunk of bone.

 

[zao275]

They need to do one of those with the pathologist and the orthopedic surgeon asking for neutrophil counts. Especially when they send you a chunk of bone.

Those are the worst!🙁