goodbye sdn path

[mcfaddens]

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Yes this article is an ominous sign to coumminty pathologists. We started subspecializing about ten years ago and bad-mouthed general pathologists since then. First the other physicians (surgical and medical subspecialists) bought into us and even if they went into private practice as gastros and pulmos or ents, they wanted subspecialty pathologists to sign out their case. Now the NYT has exposed you to the public and pathologists like Mary Erdington from MDA and many others are saying send every diagnosis to academia for review.

I tell you this is a landmark article and look it is the #1 emailed article. This article will change everything.

Private practice is kaput.

And I for one believe that 99% of breast biopsies are routine and that the decent PP pathologists know which ones to send out, but this article shows that more prominent people feel that 0% of cases should be assumed to be correct and that 100% should be send out.

Everyone wonders why LADoc00 has left this board, and why the sdn path board sucks compared to the past 5-6+ yrs, well take a good look at who wastes their time posting nonsense and ridiculous propaganda. Even when there were low points on sdn path I occasionally took a peek to see what was going on, but after such bs for so long I cannot continue to keep sdn as a tab in my bookmarks bar (favorites for pc users).This forum was a great resource at one time, it guided me from the tough decision to choose path, great residency interview questions to ask, and was a sounding board for residency issues as well as the great "online unknown conference thread". I met some good friends thru sdn path and will always cherish the positive influence this forum had given me. Unfortunately, I feel that this forum has been spoiled by immature and ill informed voices who do not quit. I feel that this once great resource is now lost. I only hope that those of you out there that have an actual interest in performing the art of medicine with pathology as your speciality find a forum to express your concerns, hopes and expectations in the environment that existed here a few years ago. This is my last post GODSPEED

 

[pathstudent]

Everyone wonders why LADoc00 has left this board, and why the sdn path board sucks compared to the past 5-6+ yrs, well take a good look at who wastes their time posting nonsense and ridiculous propaganda. Even when there were low points on sdn path I occasionally took a peek to see what was going on, but after such bs for so long I cannot continue to keep sdn as a tab in my bookmarks bar (favorites for pc users).This forum was a great resource at one time, it guided me from the tough decision to choose path, great residency interview questions to ask, and was a sounding board for residency issues as well as the great "online unknown conference thread". I met some good friends thru sdn path and will always cherish the positive influence this forum had given me. Unfortunately, I feel that this forum has been spoiled by immature and ill informed voices who do not quit. I feel that this once great resource is now lost. I only hope that those of you out there that have an actual interest in performing the art of medicine with pathology as your speciality find a forum to express your concerns, hopes and expectations in the environment that existed here a few years ago. This is my last post GODSPEED

My statement was over the top and I apologize, but I do think that article yesterday was an ominous sign. And we all just got emails from Bauer saying that article undermined all pathologists. Plus I still can't believe that Breast Pathologist from MDA saying that every breast biopsy needs to be reviewed by academics and tells patients to send it to one of the US NEWS and World Report Medical Centers. She just undermined every single hardworking pathologist other than a handful of her collegues. I think we need to question why is she unable to train residents to read breast biopsies. If general pathologists suck, then it is a reflection of the teaching abilities of Mary Enterberg.

 

[pathstudent]

My statement was over the top and I apologize, but I do think that article yesterday was an ominous sign. And we all just got emails from Bauer saying that article undermined all pathologists. Plus I still can't believe that Breast Pathologist from MDA saying that every breast biopsy needs to be reviewed by academics and tells patients to send it to one of the US NEWS and World Report Medical Centers. She just undermined every single hardworking pathologist other than a handful of her collegues. I think we need to question why is she unable to train residents to read breast biopsies. If general pathologists suck, then it is a reflection of the teaching abilities of Mary Enterberg.

You know I have been thinking more about this, and I think it is time for academia and private practice to unite. I can't believe this comment by Mary Enterberg from MD Anderson. But I have heard that MDA likes to nit-pik the diagnoses from outside institutions even if it has no treatment or prognostic difference (i.e. if you call it high grade they will call it intermediate grade and if you call the same case intermediate grade they will call it high grade).

Perhaps Mary Edgerton is of this same spirit.

I have talked to older academics who have warm relations with older private practice pathologists while younger ones have complete disdain for them. I think it is time to go back to the older days.

But no matter what, it is still time to question Mary Edgerton and ask her why is she so incompetent as a teacher to train resident and fellows to give an intelligent opinion. She said that every breast biopsy should be reviewed by her or someone like her. So seriously she must think all MDA residents are incompetent ****s if they can't diagnose DCIS. Aren't there any MDA residents/fellows that read these threads. Is she really that poor of a teacher, so much so that you can't read a breast biopsy. Are MDA residents really that poorly trained? Should you even consider them for residency if your own attendings consider you incompetent to diagnose something as simple as DCIS or IDC?

 

[KCShaw]

Bit extreme, but there might be a good point in there somewhere.

It's been a common complaint among just about every surgical pathologist I've worked with that certain consulting institutions or pathologists make a point of slightly disagreeing with the referring pathologist "just to stand out." I seriously doubt it's as conscious as that, at least the majority of the time. Whether it's simply slight differences in interpretation (everyone knows certain pathologists who call certain things more or less aggressively than others sometimes even in the same practice), daily variation (everyone also knows the same slide shown to the same pathologist at different times sometimes gets slightly different interpretations), highlighting that it was a good idea the case was referred because the referring pathologist -wasn't- entirely correct, or a subconscious need to add something as part of the consultation, I dunno.

And, yeah, there are some people who need to be the bomb, and need everyone else to not be the bomb. Some of them are even successful at it.

And maybe comments in the public eye should be either very carefully phrased, or avoided altogether, as inevitably someone will take them and run with them.

 

[gschl1234]

I'm not at MDA (I don't think they have any residents, completely fellow-run I think), but on our Consult Service we sometimes will change poor diff to mod diff for example but we're not doing it just to "stand out". We have thresholds which are internally consistent and grade accordingly.

 

[KCShaw]

I'm rather confident that's the common scenario. Most consultants already stand out -- that's why they (or their institution) are being sent consults. But most referring pathologists like to already be spot-on correct/agreed-with, especially if they're being nudged into sending it out by a clinician or family requested it. Their own reputation is somewhat on the line.

 

[yaah]

Everyone wonders why LADoc00 has left this board, and why the sdn path board sucks compared to the past 5-6+ yrs, well take a good look at who wastes their time posting nonsense and ridiculous propaganda. Even when there were low points on sdn path I occasionally took a peek to see what was going on, but after such bs for so long I cannot continue to keep sdn as a tab in my bookmarks bar (favorites for pc users).This forum was a great resource at one time, it guided me from the tough decision to choose path, great residency interview questions to ask, and was a sounding board for residency issues as well as the great "online unknown conference thread". I met some good friends thru sdn path and will always cherish the positive influence this forum had given me. Unfortunately, I feel that this forum has been spoiled by immature and ill informed voices who do not quit. I feel that this once great resource is now lost. I only hope that those of you out there that have an actual interest in performing the art of medicine with pathology as your speciality find a forum to express your concerns, hopes and expectations in the environment that existed here a few years ago. This is my last post GODSPEED

The utility and enjoyment of any forum on SDN depends on its posters. What we have always needed more of is more people who will comment appropriately. There are lots of people who complain about the bad parts of the forum but don't really do anything to bring up the better parts of it (not singling you out in particular, no offense intended). Unfortunately we have had a rash of negative and unhelpful posters lately - there are always the random and unintelligeable folks around, and those who ask the same questions over and over again. And there are always the occasional disgruntled or ill-informed around. But I know for a fact that we have a large stable of experienced, thoughtful, and helpful users out there. It is just a shame that more do not participate. Some are afraid they will be identified in real life (not sure why). Some feel they have nothing helpful to contribute (which is generally not true!). Some just don't want to bother arguing or feel that their comments are going to get drowned out by other people with more time and vitriole.

 

[2121115]

But I know for a fact that we have a large stable of experienced, thoughtful, and helpful users out there. It is just a shame that more do not participate. Some are afraid they will be identified in real life (not sure why).

On this point... What percentage of pathologists do you think read this forum? I think it is A LOT more than we think. My impression is that many many pathologists read this forum but few will even admit to reading it much less posting on it. I think every resident in my program reads the forum daily but few will talk openly about it; not really sure why. No one seems to want to admit having read the forum but I often hear things that were posted here repeated almost verbatim with qualifiers like "I heard this" or "People say this or that". In fact, I have heard other pathology residents say my own posts to me using my own words not knowing it was me who posted it. Hahah! It wouldn't surprise me if tomorrow one of the residents in my program says to me "I heard that a lot of residents read that forum but nobody wants to even admit that they read it much less post". 🙂

 

[zao275]

It wouldn't surprise me if tomorrow one of the residents in my program says to me "I heard that a lot of residents read that forum but nobody wants to even admit that they read it much less post". 🙂

That would be awesome! Yes, I have heard many people talk about this forum, so I assume the lurker to poster ratio is quite high. Maybe Betsy Bennett even reads this forum to see what we all have to say about the board exam? Kind of gives you chills, doesn't it? (I actually like her and don't have any problem with her. She always comes to Residents Forum and lets residents grill her and complain about the boards, so she plays fair by my book.)

I sometimes am tempted to just start going by my real name on this forum. It is not difficult to figure out who I am, so why bother going by a fake username? I wonder if we all posted by our real names if we would be more constructive and reasonable on SDN? Or maybe we would all be too inhibited to post. Any thoughts?

 

[zao275]

On this point... What percentage of pathologists do you think read this forum? I think it is A LOT more than we think.

Since the SDN forum is so potentially influential, all the more reason for us to keep it useful and professional. Yaah has a point, that if more people contribute, it will help out a lot. Also, the more positive users that actually want to DO something rather than just complain about things, the more the culture will shift in that direction.

 

[KCShaw]

I think one has to be willing to take responsibility for any given post in any given forum, particularly a publicly accessible online one, while keeping in mind that the opinions, education, experience, and temperament of an individual may change over time (i.e., give people a break, it's conversational). In my days of gaming I thoroughly enjoyed the anonymity and ability to take on a different identity for a time. Nowadays, especially when discussing things related to my profession, while I generally don't want to be spammed or be over-accessible to any random punk, I don't make particular efforts to be "anonymous" in professional forums. It wouldn't help my credibility.

That said, I'm very much for the ability to remain as anonymous as you want, so long as the forum remains professional and productive on the whole. Especially when we have students and residents around, who may find themselves in unfortunate positions and need a degree of anonymity. And there are those who simply don't communicate well as "themselves," but are able to open up and be more honest under a cloak of relative anonymity -- this is one of the benefits of the medium.

 

[yaah]

One problem I have always noticed from being on the forums for years is that usage is cyclical - there are many users who utilize the forums during med school, particular when applying for residency. But then when they start residency they vanish (even if they still lurk). People have different reasons for this. Others post more during residency but then vanish.

There are usually reasons that people initially visit the forum, and this can be a reason why they disappear. Med students visit because they are curious about the residency process and want advice, guidance, or to hear real experiences. Residents visit because they are worried about boards, jobs, or fellowships. Attendings visit generally because they are pissed off about something.

The unfortunate thing is that once their reason for visiting is resolved (by finding a residency, finding a job, passing the boards, whatever) their visiting also disappears. It's strange to me that people who come here seeking advice don't want to provide what they have learned to help out others, but that's the way things are.

The pissed off generally stick around though, because there is always something new to be pissed off about!

 

[amygdala_path]

This is a great forum. I have posted questions often and have been helped by you guys including the OP. There is so much information that I have got from here.

Unfortunately I have not had time to post or even lurk in the last few years. As Yaah says, participation in the forum is cyclical. I would read the posts daily before the residency. Since I started, I have been busy with family and work. Now I plan to visit more often coz I will take AP/CP boards next spring and hope to see others who will and share thoughts with them.

As in life, there are all kinds of people we have to deal with. Unfortunately, this is an open forum and people are bound to say what they wish. We will just have to disregard things we dont agree with.

So anyone out there preparing for boards in spring 2011?

 

[dermpathdoc]

My statement was over the top and I apologize, but I do think that article yesterday was an ominous sign. And we all just got emails from Bauer saying that article undermined all pathologists. Plus I still can't believe that Breast Pathologist from MDA saying that every breast biopsy needs to be reviewed by academics and tells patients to send it to one of the US NEWS and World Report Medical Centers. She just undermined every single hardworking pathologist other than a handful of her collegues. I think we need to question why is she unable to train residents to read breast biopsies. If general pathologists suck, then it is a reflection of the teaching abilities of Mary Enterberg.

Oh geez that comment is nothing new...several years ago Epstein made the same comment about Prostate Biopsies...that all should only be read by urological pathologists such as him..you have to realize comments like this are meant to line the pocket of the commenter...

 

[KCShaw]

Ultraspecialists do this. Some may want the work -> money, but I think most just believe the most accurate and thorough results come from them. Most already have plenty of work to do and already make jingle with their existing consults. And there's an element of truth to their claims; I have no argument that an ultraspecialist knows more and can find more and more commonly accurately interpret when reviewing a case specific to their field, than I could. And I have no argument that they've been more likely to see gross errors on either pathologist consults sent to them or legal cases brought to their attention due to unhappy outcomes.

However, it simply does not -automatically- follow that patients will as a statistical group have significantly better outcomes if only ultraspecialists handle given cases. (Haven't there been some studies on this..? Pretty sure there's some about pathologic findings, which -are- different for some specialties/specimen types, such as placenta, but I don't know studies addressing patient outcomes, nor cost-effectiveness analysis..)

 

[zao275]

The unfortunate thing is that once their reason for visiting is resolved (by finding a residency, finding a job, passing the boards, whatever) their visiting also disappears. It's strange to me that people who come here seeking advice don't want to provide what they have learned to help out others, but that's the way things are.

Excellent point, Yaah! I have run into the same issue with the wiki. Everyone would love to find a source of reviews and inside info about residency and fellowship programs, but it's much harder to get those same people to take a few minutes to write down their thoughts about their program to share with others whose shoes they used to be in. My plan is to be nice but persistent in asking former residents and fellows for reviews/pros/cons of their training programs in order to help collect this info for the benefit of future trainees.

I agree that it is important to pay back into the system, and it is personally rewarding to do so as well.