Gross work

[Cica]

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Hey

I just completed a year in pathology residency and was wondering if and why to senior pathologists look down upon grossing? Why is it considered something that only residents should do, even call it lowstatus work!!!

I am totally confused about the double standards of senior pathologists, when on one hand they says its anextremely important part of the job and then on the other hand they say its low status work!

Any feedback? Does it get better once you are finished with rsidency? Is it worth it?
I am feeling a bit confused and am questioning my beinghere. I am genuinely interested inthe subject and am ok with most aspects of the job. But when I hear such things and see this bwhaviour in my seniors, I wonder if its worth it.

Thanks for your inout in advance.

 

[pathstudent]

Because if your an international expert pathologist (I.e Robert young or Elaine jaffe) you can benefit the world much more and have a much more interesting intellectually stimulating career doing consults, writing papers an speaking at conferences than doing ruddy lymph node dissections on a colon case.

We were taught that there is no bigger waste of pathologists time than grossing.

 

[mlw03]

It's about money, in my view, especially in a world of PAs. Grossing a colectomy (and spending time hunting for lymph nodes in a patient who received neoadjuvant therapy) takes time, time that could be spent signing out cases, which is what ultimately generates revenue. PAs cannot sign out cases, and thus cannot generate revenue.

 

[yaah]

It's not low status work. It's a critical part of the diagnosis of specimens, often more important than the microscopic in many cases.

However, it is time consuming and much of it does not require the same level of training as does the microscopic work. And as said above, having it done by others allows pathologists more time to do other things. One should never have the grossing done by someone who doesn't know what they're doing, that is a recipe for disaster. In residency training, learning the gross exam is obviously important.

I'm not sure why you think senior pathologists "look down" on grossing. If they truly look down on grossing they are not going to be as effective. Most specimens are fairly routine, however. It can take quite awhile to gross in a colon or a large resection specimen.

 

[Thrombus]

The initial post is one of many reasons we need reform in academic pathology. I personally prefer to gross the specimens I sign out. I believe this practice delivers optimal patient care and also makes me more efficient as a pathologist. If you disregard the career implications, I would tell the attending academic pathologist to get their arse in the gross room and help you provide care for your patient. Of course I wouldn't recommend doing this as it would be career suicide and most academic training programs are more interested in their residents being underpaid accessioners/PA's and their subsidized paychecks.

 

[pathstudent]

Of course senior pathologists look down on grossing. Go ask Elaine jaffe, Robert young, Sharon Weiss, odze, lefkowitch, burger, Epstein, fletcher to spend their afternoon doing lymph node dissections. They would tell you to go fly a kite even if they had nothing else to do.

It's not low status work. It's a critical part of the diagnosis of specimens, often more important than the microscopic in many cases.

However, it is time consuming and much of it does not require the same level of training as does the microscopic work. And as said above, having it done by others allows pathologists more time to do other things. One should never have the grossing done by someone who doesn't know what they're doing, that is a recipe for disaster. In residency training, learning the gross exam is obviously important.

I'm not sure why you think senior pathologists "look down" on grossing. If they truly look down on grossing they are not going to be as effective. Most specimens are fairly routine, however. It can take quite awhile to gross in a colon or a large resection specimen.

 

[MetroPath]

The initial post is one of many reasons we need reform in academic pathology. I personally prefer to gross the specimens I sign out. I believe this practice delivers optimal patient care and also makes me more efficient as a pathologist. If you disregard the career implications, I would tell the attending academic pathologist to get their arse in the gross room and help you provide care for your patient. Of course I wouldn't recommend doing this as it would be career suicide and most academic training programs are more interested in their residents being underpaid accessioners/PA's and their subsidized paychecks.

Some of my attendings forgot how to gross.

 

[Substance]

Hey

I just completed a year in pathology residency and was wondering if and why to senior pathologists look down upon grossing? Why is it considered something that only residents should do, even call it lowstatus work!!!

I am totally confused about the double standards of senior pathologists, when on one hand they says its anextremely important part of the job and then on the other hand they say its low status work!

Any feedback? Does it get better once you are finished with rsidency? Is it worth it?
I am feeling a bit confused and am questioning my beinghere. I am genuinely interested inthe subject and am ok with most aspects of the job. But when I hear such things and see this bwhaviour in my seniors, I wonder if its worth it.

Thanks for your inout in advance.

Sounds to me its like placing an ECG or positioning a patient for an xray. It's important but you never see attending staff do it because it doesn't add value. It's scut.

 

[LADoc00]

Grossing is essential work. Even at the highest levels of our profession.

In this way, I think Academics do an incredible disservice to the field because in all my years at all the different ivory towers I traveled through I think I saw a professor step into the grossing area once and that was merely to berate a trainees for misorienting a breast case.

Academics have done a great job of perpetuating the impression that grossing is merely slave work when often some of the most importation observations for patient care are done at this level.

Something to think about.

 

[Enkidu]

Sounds to me its like placing an ECG or positioning a patient for an xray. It's important but you never see attending staff do it because it doesn't add value. It's scut.

Maybe grossing a biopsy is scut, but there is a lot going on with bigger specimens. I think gross exam of an autopsy brain, for instance, is always done by the attending neuropathologist at my institution.

 

[maji]

Our pathologists, both senior and junior, routinely come into the gross room to see specimens. I actually prefer them to see anything complicated so they have a sense the next day. A lot of the junior staff are happy to put on gloves and examine the specimen, especially if it comes for frozen section.

 

[2121115]

Our pathologists, both senior and junior, routinely come into the gross room to see specimens. I actually prefer them to see anything complicated so they have a sense the next day. A lot of the junior staff are happy to put on gloves and examine the specimen, especially if it comes for frozen section.

Fantasyland!

 

[LIT2012]

Grossing biopsies is time-wasting. But grossing resections is essential part of understanding pathology. Everybody has to go through the stages. Attendings had done this when they were residents. They paid their dues. Now you want to join the club? You do the same.

Whenever I have a complicated gross case, I called the attending who will sign out the case to take a look, so that he/she is aware of some special findings, and won't be surprised at signout.

Hey

I just completed a year in pathology residency and was wondering if and why to senior pathologists look down upon grossing? Why is it considered something that only residents should do, even call it lowstatus work!!!

I am totally confused about the double standards of senior pathologists, when on one hand they says its anextremely important part of the job and then on the other hand they say its low status work!

Any feedback? Does it get better once you are finished with rsidency? Is it worth it?
I am feeling a bit confused and am questioning my beinghere. I am genuinely interested inthe subject and am ok with most aspects of the job. But when I hear such things and see this bwhaviour in my seniors, I wonder if its worth it.

Thanks for your inout in advance.

 

[maji]

Fantasyland!

Well, it's no fantasy here...

 

[wp746911]

Agree- in residency it was 'the most important part of pathology, but if you call me to come look I'll be pissed (at least for some attendings)''.

Now im in a moderate size community private practice, and we do a lot of our own gross. Often I don't wish we did, but I guarantee you I have a better handle on my cases than almost any PA gross/pathologist signout setup out there. I am able to optimize every aspect of every slide to illustrate exactly what I see, and I already have a wonderful idea of what the slides will show the next day before I get them. I can optimize random cases for maximal turn around time. I don't get tripped up over artifact. I am just able to smell when something is funny. Also, I dare say I can do a mean lymph node dissection. Just a much more thorough complete examination all around.

The reason attendings don't like to do it is it's messy (placentas, yuck!) and time consuming. In general, in medicine (and life) we tend to have the lowest trained/paid person do the work. Doctors don't take blood pressures, nurses don't even often do it- nurse's aids do- and about 75% of them do it very incorrectly. Surgeons often don't do closings- their assistant does it- so the surgeon can do something else. But hey it gets done...albeit not as well. Not saying PAs are bad- they are very good- just saying for efficiency reasons we have someone lower on the payscale do it. Also, as pointed out, academically you ain't going anywhere writing gross manuals. Medicare pays the same if Jaffe does the LN touch preps, or a PA...

 

[member0007]

the grossing of a specimen is an integral aspect of anatomic pathology such as surgical and autopsy pathology, who wouldn't want to be part of all this excitement???? also, can we talk about how signing out is essentially a time consuming venture?

 

[KCShaw]

I agree that money and time are large parts of it. Learned ignorance can be a part of it too. I've also gotten the sense at times that some attendings simply don't know how to interpret a gross finding and feel uncomfortable about that; sometimes one is -supposed- to just say I dunno let me look at the micro, but sometimes the gross is important and self evident for those who know what they're looking at. But it takes time, isn't an independent money maker, and doesn't "require" an MD, much less a board certified pathologist, to do it. There should be a better balance there somewhere, but cost/benefit is a very real issue. Did pathologists do more of their own grossing 20-30+ years ago?

More or less the same thing seems to have happened in the clinical setting, as fewer attendings appear likely to be involved in technician/nursing/medical student/resident duties like taking blood, placing a catheter, even placing a central line in some institutions, etc. -- they may get through more patients in a day, but simultaneously become less and less knowledgeable about the details of how things do and don't work, what is and isn't practical or useful, and so on.