How important is histology?

[GreenShirt]

At my school they don't teach histology....at least not the traditional bolus of histology most students get at the beginning of MS-I. Some of our power points include histology images and the lecturers point out aspects to us, but we never get tested on identifying images. There's definitely no looking at slides under a microscope. I think the school doesn't emphasizes it because pathology is the only specialty in which you need to be proficient at identifying histo samples, so it's better to focus on the physiology and pharmacology most physicians need to know. However, I've noticed that there are a fair number of histo questions on some of the NBME practice exams we take. Is histology a significant portion of the boards? Should I spend this part of this summer curled up with BRS histo?

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[lord_jeebus]

I think I only got 2 or 3 pure histo questions on Step I. Interpreting path slides was much more important.

However I think a strong histo foundation is very useful for learning pathology.

 

[SplenoMegastar]

Your school might integrate it with your Path or Bio of Dz course next year. Like a compare and contrast deal.

 

[GreenShirt]

Your school might integrate it with your Path or Bio of Dz course next year. Like a compare and contrast deal.

Well, since we're system-based we incorporate all the basic sciences including path, pharm, etc. throughout the first two years. We also see a lot of pathology slides, but once again we are not tested on anything visual in pathology. For pathology we only get written questions such as: Which is the most common cancer in blank? Or which tumor contains stellate cells?

So is it safe to say that they're aren't a lot of histo or path slides on the USMLE?

 

[dpmPOD]

I think a strong histo foundation is very useful for learning pathology.

 

[Blesbok]

Usually it isn't required, but a lot of the time it helps. The majority of the histo stuff that I have seen on the board prep (Reid Sternberg cells, psammoma bodies, etc) we learned about in pathology during second year, not in the histology stuff from first year.

 

[Slide]

I hope you guys are right about Histo on the step 1, I hated that class even to an emotional level. That class was more about memorizing five sentences exactly on a page rather than any actual scientific reasoning.

 

[AmoryBlaine]

I think I only got 2 or 3 pure histo questions on Step I. Interpreting path slides was much more important.

However I think a strong histo foundation is very useful for learning pathology.

thumbdown

Please explain what you mean by this. If you mean "pathology" with a capital "P" as in the specialty I might agree with you. However, for the average medical student to spent any great deal of time looking at slides is a collosal waste of time.

To the rest of you: histo is the 2nd most useless topic for the USMLE (embryo being #1). You can destroy step1 w/o ever having reviewed histo. You can honor every 3rd year clerkship w/o knowing anything about histo.

 

[lord_jeebus]

I meant it as in a 2nd year Pathology course.

For 3rd year it's worthless. For practicing any non-Pathology field of medicine it's worthless.

I had a bunch of path slides on Step I. Maybe that's just me?

 

[notdeadyet]

thumbdown

Please explain what you mean by this. If you mean "pathology" with a capital "P" as in the specialty I might agree with you. However, for the average medical student to spent any great deal of time looking at slides is a collosal waste of time.

Actually, I'm with Jeebus on this. A good visual knowledge of histo is going to be important for pathology (the subject). And isn't path a pretty big one on the boards?

OP- I don't think you're missing out on much by not being able to use actual microscopes, but you might need to go through the Utah path site at some stage so that Path makes more sense if they try teaching that non-visually (having a tough time wrapping my head around that).

 

[AmoryBlaine]

Actually, I'm with Jeebus on this. A good visual knowledge of histo is going to be important for pathology (the subject). And isn't path a pretty big one on the boards?

OP- I don't think you're missing out on much by not being able to use actual microscopes, but you might need to go through the Utah path site at some stage so that Path makes more sense if they try teaching that non-visually (having a tough time wrapping my head around that).

Please elaborate on specific situations when a "visual knowledge" of histo contributes to actual understanding of path.

Maybe some people need to look at slides of tissue changes after an MI to understand loss of viable, pumping, myocardium but I am not one of them.

Similarly some people may gain a deeper understanding of renal failure by looking at scarred glomeruli but in the real world we look at BUN/Cr, not slides.

 

[Blesbok]

Please elaborate on specific situations when a "visual knowledge" of histo contributes to actual understanding of path.

Maybe some people need to look at slides of tissue changes after an MI to understand loss of viable, pumping, myocardium but I am not one of them.

Similarly some people may gain a deeper understanding of renal failure by looking at scarred glomeruli but in the real world we look at BUN/Cr, not slides.

If you go through your entire medical career without sending one sample to a pathologist, I will be thoroughly impressed. You may not need to know it in the specific field that you go into, but that doesn't mean you shouldn't know what the hell the pathologist is talking about when he reports back to you. How many surgeons need to know what a t(9;22) is? But everyone still learns that, don't they? Why? Because it is important to have at least a little understanding of all fields of medicine. Your posts in this thread are chock full of ignorance.

 

[AmoryBlaine]

If you go through your entire medical career without sending one sample to a pathologist, I will be thoroughly impressed. You may not need to know it in the specific field that you go into, but that doesn't mean you shouldn't know what the hell the pathologist is talking about when he reports back to you. How many surgeons need to know what a t(9;22) is? But everyone still learns that, don't they? Why? Because it is important to have at least a little understanding of all fields of medicine. Your posts in this thread are chock full of ignorance.

Ah, SDN. Where to begin...

1. Get ready to be impressed, I am matched in emergency medicine, so unless you count blood tests I very well might go through my entire career without sending a single sample to a pathologist. We try to avoid biopsies in the ED if at all possible.

2. "It is important to have at least a little understanding of all fields of medicine." Probably true. In that light I would suggest that you start designing a preclinical cirricula to teach us the "t(9:22) equivalent" in the following fields:
hyperbaric medicine, sleep medicine, transplant hepatology, clinical cytogenetics, medical genetic pathology, obstetrical critical care, hand surgery, blood banking, pediatric hospice, pediatric neurodevelopement, pediatric transplant hepatology, pediatric sleep medicine, spinal cord injury medicine, psychosomatic medicine, forensic psych, and diagnositc radiological physics.*

By your logic it would be ignorant to not know what your friendly neighborhood pediatric transplant hepatologist was talking about. I would even ask you for a brief discussion of hyperbarics or psychosomatic medicine but there would be no way to prove that you hadn't googled them to respond.

3. Usually when a thread is proceeding in a manner of reasonable discussion you add very little by calling one of the posters "ignorant."


* All of these are approved specialties by the ABMS http://www.abms.org/Who_We_Help/Physicians/specialties.aspx

 

[Blesbok]

Ah, SDN. Where to begin...

1. Get ready to be impressed, I am matched in emergency medicine, so unless you count blood tests I very well might go through my entire career without sending a single sample to a pathologist. We try to avoid biopsies in the ED if at all possible.

2. "It is important to have at least a little understanding of all fields of medicine." Probably true. In that light I would suggest that you start designing a preclinical cirricula to teach us the "t(9:22) equivalent" in the following fields:
hyperbaric medicine, sleep medicine, transplant hepatology, clinical cytogenetics, medical genetic pathology, obstetrical critical care, hand surgery, blood banking, pediatric hospice, pediatric neurodevelopement, pediatric transplant hepatology, pediatric sleep medicine, spinal cord injury medicine, psychosomatic medicine, forensic psych, and diagnositc radiological physics.*

By your logic it would be ignorant to not know what your friendly neighborhood pediatric transplant hepatologist was talking about. I would even ask you for a brief discussion of hyperbarics or psychosomatic medicine but there would be no way to prove that you hadn't googled them to respond.

3. Usually when a thread is proceeding in a manner of reasonable discussion you add very little by calling one of the posters "ignorant."


* All of these are approved specialties by the ABMS http://www.abms.org/Who_We_Help/Physicians/specialties.aspx

You list an impressive group of specialties, all of which I would bet 99% of MS2+ SDNers knows a little bit about. If you didn't learn anything in any of those fields, you are right, you should talk to your course directors about refining your school's curriculum. The point being that medical school is meant to prepare all students for all residencies so that they may decide on their own which specialty they would like to pursue. Just because you feel that you have no use for histology does not mean that the rest of the medical school population feels that way.

And like I said, if you manage to not send a single sample to a pathologist, give me a call in 50 years and I will congratulate you on being the first.

 

[AmoryBlaine]

You list an impressive group of specialties, all of which I would bet 99% of MS2+ SDNers knows a little bit about. If you didn't learn anything in any of those fields, you are right, you should talk to your course directors about refining your school's curriculum. The point being that medical school is meant to prepare all students for all residencies so that they may decide on their own which specialty they would like to pursue. Just because you feel that you have no use for histology does not mean that the rest of the medical school population feels that way.

And like I said, if you manage to not send a single sample to a pathologist, give me a call in 50 years and I will congratulate you on being the first.

You think medical school prepares the average student to make an educated decision about hyperbarics or radiation physics?

As to your last point, what are you talking about? Do you think ER doctors biopsy patients or remove organs and send samples to pathologists? That is just silly.

 

[cpants]

You think medical school prepares the average student to make an educated decision about hyperbarics or radiation physics?

As to your last point, what are you talking about? Do you think ER doctors biopsy patients or remove organs and send samples to pathologists? That is just silly.

Not knowing about hyperbarics or radiation physics is a little different than not knowing all of histology. Learning the histo well is helpful for path, and also helps a lot with understanding the physiology of different organ systems. It is pretty fundamental background knowledge.

 

[OncoCaP]

I guess it depends on how your histo is taught. Our histo prof is one of the better ones / more memorable profs. He goes on and teaches parts of neuro and other course. He basically lays the foundation for just about everything in his histo class (neuro, CV, path, pharma, etc.). You need to be able to recognize any important cell or tissue, what it does, what's in it, what else to look for elsewhere if you see a certain pathology, what clinical symptoms you see if the tissue is damaged, name the enzymes, what to look for on labs, etc. It's one of the more challenging courses and pulls everything together at the cellular and tissue level. We get tested on common lab values, learn what an eosinophil is and how its different from a basophil, lay the foundations for immuno, micro, etc. I call it medical cell biology. I guess you really don't need to know biology to become a physician, but it certainly makes sense to me. We don't use real microscopes; we use powerpoint and his old 35 mm slides. He will show things on microscope slides sometimes if there was an interesting patient case or if he has particularly good slide we don't have in print or electronic form. There is this computerized digital microscope imaging piece of junk (software histo slides) that some people look at as well.

 

[QuantumMechanic]

As to your last point, what are you talking about? Do you think ER doctors biopsy patients or remove organs and send samples to pathologists? That is just silly.

In season 2 of ER, John Carter biopsies a 'mole' from a man's arm which comes back from the pathologist read as a melanoma. He proceeds to do a lymph node biopsy himself.

GOTCHA!

 

[Blesbok]

You think medical school prepares the average student to make an educated decision about hyperbarics or radiation physics?

As to your last point, what are you talking about? Do you think ER doctors biopsy patients or remove organs and send samples to pathologists? That is just silly.

Medical school doesn't prepare you to practice heme either. If it did there wouldn't be a heme/onc residency. All I said is that medical school prepares you to enter any type of residency and that it teaches everyone a little about everything as to not close any doors. If you honestly think histology has no place in medical school you are entitled to your opinion, but good luck in life with such a closed mind.

 

[shreypete]

Histo. is a very important course in my medical school. We have general histology in the winter semester, followed by Particular Histology and Embryology (which sucks big time!!! as it's done in blocks except that they only spend a month of embryology).

But anyways a strong understanding of histology will go a long way when you're doing Pathology (which is in my 3rd year).

 

[yaah]

Sigh. The dumbing down of medical education continues. Eliminating more things that help you understand the fundamentals behind disease, anatomy, disease processes, etc etc does not help one become a better doctor. Oh well. Such is the way things are going though.

I learned pharmacology which is basically worthless for a pathologist. Part of medicine is learning about all the different fields, not just the ones you are interested in. Limiting yourself in that fashion is not a good habit to start.

 

[dilated]

We had minimal histo at our school and I picked up the step 1 material easily in four weeks of studying. Almost all of the step 1 slides are "visual buzzwords", you just have to recognize which buzzword it is. Most of them are pathetically easy, like spherocytes.

Personally I hated histology because slide interpretation is so damn useless for non-pathologists, focusing on descriptions of histology findings (the only thing the rest of us will see) would be far more useful.

 

[soonereng]

Personally I hated histology because slide interpretation is so damn useless for non-pathologists, focusing on descriptions of histology findings (the only thing the rest of us will see) would be far more useful.

That is actually a very good point. Recognizing in verbage what one has (maybe) learned to recognize in slide form is definitely not the same.

 

[QuantumMechanic]

Almost all of the step 1 slides are "visual buzzwords", you just have to recognize which buzzword it is. Most of them are pathetically easy, like spherocytes.

Aren't spherocytes abnormal, and thus under the realm of pathology instead of histo?

 

[BigRedBeta]

As so far as I've gone through my 3rd year, interpreting histology slides (and path slides for that matter) is a useless skill. You wait for the path report to come back, read it, then look at the slides and go "oh, that's what that is". It's not like x-rays or CT's where there's some expectation that you can look at those on your own and start a differential. Maybe it's different at other schools.

I think my school spent far too much time on path slides during second year (I probably think that because I HATE looking at slides and always scored poorly on the slide portion of our exams). My initial thought whenever I see a slide is "oooh, pretty pink and purple picture!" I agree with whoever said knowing "buzz words" is more important. Now that I've said this I'll probably get burned on Step 2.

 

[DarksideAllstar]

You think medical school prepares the average student to make an educated decision about hyperbarics or radiation physics?

As to your last point, what are you talking about? Do you think ER doctors biopsy patients or remove organs and send samples to pathologists? That is just silly.

--Brief thread hijack--

ER physicians send **** to the clinical lab all the time-- CBCs, hcg, chem7s, , type and screen, etc. If ER docs never send anything to a pathologist why do I get all sorts of crazy pages at night and on the weekend about possible interfering substances with regard to xyz result? We oversee all the QC/QA for every test you want to run.

Part of the issue here is that most non-pathologists are rather uneducated about what we actually do to facilitate clinical care. At some point in your career you will call one of us.

Lots of subspecialties have histopathology on the board exams-- pulmonary, hem/onc, nephrology, GI/Liver, neurology, etc. That's why we give almost weekly conferences for each of these services-- they are expected to know more than f*ck*ng buzzwords.

--End thread hijack--

As to the OPs original question, histo is low-yield for step 1. Histo at my school was very bad and I think I only had 4 or 5 questions on my step 1.

 

[dilated]

Aren't spherocytes abnormal, and thus under the realm of pathology instead of histo?

Well, technically yeah. But there's almost no pure histo on the boards (except for the occasional EM). Basically I tend to lump everything involving "the art of interpreting slides" into histology (or histopath if you prefer).

 

[AmoryBlaine]

So much to respond to...

1. I am not claiming that histo has no value in medical education, I never said that. I am claiming that looking at tissue slides is incredibly low-yield from a learning standpoint.

2. In one of my first posts I challenged someone to tell me a situation where slides contributed significantly to understanding clinical pathophysiology. I will return to my previous example of the post-MI myocardium. You can look at slides of PMNs/macrophages slowly creeping in until the cows come home, but I maintain that such slides are not neccesary to understanding the significance of a fibrotic ventricle.

3. I disagree with the statement that sending blood for basic labs is "sending a sample to a pathologist" in they way that most of us understand it. Yes, I know that clinical pathologists oversee chem/heme labs in every hospital. I have actually spent some time in such labs and have noted that when I send a CBC from the ER it is a tech putting it in a machine - not a pathologist. Heck, I think even manual diffs are done by techs.

3.5. Let me be clear that I am ecstatically glad that good, well-trained pathologists are down in the basement making sure the clinical lab runs smoothly. I am not trying to disparage them. I am merely trying to say that sending down a tube of blood doesn't constitute a "path consult."

4. Yaah - I am hardly advocating the "dumbing down" of medical education, quite to the contrary I take issue with our being force-fed old school knowledge that 95% of us will never apply. The future of medicine, my friend, is not in light microscopy.

4.5. This emphasis on low-yield information is part of the reason that MedEd sucks so bad. We spend 2 years memorizing largely useless things that we all forget while never really learning how to think through problems or (god forbid) read a journal article critically. Then we hit the wards and our superiors smugly tell us that "patients don't read the book." Well, duh, but guess what? All we do is read the freaking book and it's full of crap!

5. Blesbok - Having ideas about medical education that you don't agree with does not mean that I am "close-minded." You seem to be implying that my future in medicine is tenuous because I don't agree with the emphasis placed on histology during M1 year. This is one of the most fun things about SDN, in an anonymous internet forum people decide that you are going to have a tough life and a bad career because they disagree with you on some trivial issue. Guess what partner? I'm already Matched and at a damned good emergency medicine program but I'll be sure and let you know when my lack of respect for histology puts my career into a tailspin.

 

[Gyric]

Of course manual diffs are done by techs … in the ED you will not be doing all your own blood draws, but you will be responsible if the nurse screws up. It is the same in the lab, we hire and train techs (many of whom have an equivalent level of education as an RN) to do specific jobs, but we are still responsible for the outcome (e.g. WE get sued if that one CBC is screwed up). In that sense every test you order from the lab IS a consult. Automation allows us to hire fewer techs and focus more on tissue based diagnosis.

AmoryBlaine, I don’t expect you to have a broad knowledge of clinical pathology and if you want to view the lab as a black box that spits out your diagnoses, that is your choice, but for your patient’s sake, please learn to recognize when you need our help, because you will, I work with ED attendings (never residents interestingly) all the time on transfusion and heme issues.

 

[AmoryBlaine]

Of course manual diffs are done by techs … in the ED you will not be doing all your own blood draws, but you will be responsible if the nurse screws up. It is the same in the lab, we hire and train techs (many of whom have an equivalent level of education as an RN) to do specific jobs, but we are still responsible for the outcome (e.g. WE get sued if that one CBC is screwed up). In that sense every test you order from the lab IS a consult. Automation allows us to hire fewer techs and focus more on tissue based diagnosis.

AmoryBlaine, I don’t expect you to have a broad knowledge of clinical pathology and if you want to view the lab as a black box that spits out your diagnoses, that is your choice, but for your patient’s sake, please learn to recognize when you need our help, because you will, I work with ED attendings (never residents interestingly) all the time on transfusion and heme issues.

1. You are responding to a 3 month old post but since I have nothing else to do I'll bite.

2. I think you are responding to assertations that I did not really make.

3. Please cite for me (and I am asking this in a good faith desire to learn) one example of a pathologist being taken to court for a incorrect CBC. I would be especially interested to know of a jury decision against a pathologist for the same.

4. I have in no way suggested that I view the lab as a "black box" for spitting out lab results. The discussion on this thread centered around the utility of light microscopy pathology in medical education. From where are you pulling this stuff?

5. Please tell me, in some detail, about conversations you have had with EM physicians while on duty. While I don't doubt that they have occured, I take issue with your characterization of EM-path discussions happening "all the time." At this point I have spent a decent amount of time in 5 separate emergency rooms, all at tertiary care centers. I have seen multiple transfusions/heme patients and have yet to see the attending ask to "page the pathologist on call."

6. Do pathologists at your institution take emergency room call?

 

[RxnMan]

To the OP: I just took Step 1, and there was a few questions (6-7) where histo knowledge could help. All but two (out of a 343 question exam,) you could get without looking at the pic. If you really want to make it part of your knowledge, then put histo in the contex of the disease - classic presentation + classic histo pic + pharm/treatment. That's all you need.

 

[DarksideAllstar]

5. Please tell me, in some detail, about conversations you have had with EM physicians while on duty. While I don't doubt that they have occured, I take issue with your characterization of EM-path discussions happening "all the time." At this point I have spent a decent amount of time in 5 separate emergency rooms, all at tertiary care centers. I have seen multiple transfusions/heme patients and have yet to see the attending ask to "page the pathologist on call."

1. Wow, just two weeks ago I was called re: PRBCs for a patient in the ED. Pt is a woman with CAD, h/o AML s/p allo tx, received multiple transfusions, now with a Hb of 4, with chest pain and ST elevation on EKG. She has a couple of known antibodies, but units negative for those antigens are still positive on cross match. I got a page at 0200 from the EM resident asking me what to do. So yeah, these conversations do occur, and they occur with regularity at large academic centers. Sorry that you haven't had the priviledge of paging me at 3am yet. Maybe you should find another medical center to rotate at.

2. The future of modern medicine is largely dependent on light microscopy, more specifically oncology. You can't treat a patient correctly with fancy medicines if you don't have the right diagnosis. In addition, the therapy for many medical conditions seen in GI, pulm, and nephrology are dependent on biopsy findings (treat/no treat; if treat, which drugs, etc.)

3. And yeah, I've looked at plenty of manual diffs, and many of us have seen things on a peripheral smear suggestive of a process that the clinical team didn't even have on their differential.

This thread is hilarious. And I still stand by my original statement that histo is useless for step 1. I don't particularly care if people learn it or not. I don't care if you look at slides or not. What I do know is that it is important to patient care.

 

[AmoryBlaine]

1. Wow, just two weeks ago I was called re: PRBCs for a patient in the ED. Pt is a woman with CAD, h/o AML s/p allo tx, received multiple transfusions, now with a Hb of 4, with chest pain and ST elevation on EKG. She has a couple of known antibodies, but units negative for those antigens are still positive on cross match. I got a page at 0200 from the EM resident asking me what to do. So yeah, these conversations do occur, and they occur with regularity at large academic centers. Sorry that you haven't had the priviledge of paging me at 3am yet. Maybe you should find another medical center to rotate at.

2. The future of modern medicine is largely dependent on light microscopy, more specifically oncology. You can't treat a patient correctly with fancy medicines if you don't have the right diagnosis. In addition, the therapy for many medical conditions seen in GI, pulm, and nephrology are dependent on biopsy findings (treat/no treat; if treat, which drugs, etc.)

3. And yeah, I've looked at plenty of manual diffs, and many of us have seen things on a peripheral smear suggestive of a process that the clinical team didn't even have on their differential.

This thread is hilarious. And I still stand by my original statement that histo is useless for step 1. I don't particularly care if people learn it or not. I don't care if you look at slides or not. What I do know is that it is important to patient care.

1. I don't think I need to seek out experiences in emergency medicine that allow me to page pathologists to have a well-rounded education. All of my rotations have been at academic centers.

2. Wrong. Cancer diagnosis will continue to move towards genomics. Don't kid yourself, I've done Heme -- everyone gets a genotype.

3. It's only important to patient care if you go into Pathology or Heme/Onc.

 

[yaah]

2. Wrong. Cancer diagnosis will continue to move towards genomics. Don't kid yourself, I've done Heme -- everyone gets a genotype.

This is part of the reason why students need to be taught more histo and pathology. Presuming that genomics makes the diagnosis. Do you know how genomics is integrated into a diagnosis? You have to know where to start. You don't just throw blood or tumor tissue on a machine and randomly ask it what the diagnosis is - it gets evaluated and triaged and certain things are queried. And what you are suggesting is a remarkably inefficient and costly way to make any diagnosis. Genomics is coming more into play with tumors that are already diagnosed - looking for markers that indicate resistance/sensitivity to certain drugs, certain prognostic factors. It's basically worthless if you don't understand why you're ordering the test or it's ordered on the wrong specimen. As the years go forward, molecular techniques will add more and more to diagnostic and prognostic methods, but to suggest it is the panacea or the ultimate arbiter is pure ignorance.

Certain diagnoses (CML, some myeloproliferative disorders) are at or reaching the stage where some biopsy findings are basically irrelevant, but that is because morphology is so accurate and nearly diagnostic on peripheral blood, and the diseases are quite reproducible in their mutations. This is far from true from other diseases.

Someone made a comment about how all you need to know about pathology is to pick up the report, read the diagnosis, and then go act on it. As if understand the diagnosis and other things that go into making it (such as the limitations) were completely irrelevant. Have you ever been to a tumor board? Ever seen a diagnosis change when an expert reviews the slides? This is akin to saying that pathologists don't need any clinical history or data or understanding of diseases processes to make an accurate diagnosis. That would be insanity.

As for the claim that pathology knowledge is only important if you go into path or heme-onc, that is so laughable and ludicrous that it doesn't deserve a response. I am not saying everyone should know how to diagnose difficult cases of ulcerative colitis on biopsy, but a basic understanding of changes and pathology is crucial to learning and being an effective physician. If your goal is not really to be an effective physician, then go ahead and stop your learning, I won't argue.

 

[Depakote]

This is part of the reason why students need to be taught more histo and pathology. Presuming that genomics makes the diagnosis. Do you know how genomics is integrated into a diagnosis? You have to know where to start. You don't just throw blood or tumor tissue on a machine and randomly ask it what the diagnosis is - it gets evaluated and triaged and certain things are queried. And what you are suggesting is a remarkably inefficient and costly way to make any diagnosis. Genomics is coming more into play with tumors that are already diagnosed - looking for markers that indicate resistance/sensitivity to certain drugs, certain prognostic factors. It's basically worthless if you don't understand why you're ordering the test or it's ordered on the wrong specimen. As the years go forward, molecular techniques will add more and more to diagnostic and prognostic methods, but to suggest it is the panacea or the ultimate arbiter is pure ignorance.

Certain diagnoses (CML, some myeloproliferative disorders) are at or reaching the stage where some biopsy findings are basically irrelevant, but that is because morphology is so accurate and nearly diagnostic on peripheral blood, and the diseases are quite reproducible in their mutations. This is far from true from other diseases.

Someone made a comment about how all you need to know about pathology is to pick up the report, read the diagnosis, and then go act on it. As if understand the diagnosis and other things that go into making it (such as the limitations) were completely irrelevant. Have you ever been to a tumor board? Ever seen a diagnosis change when an expert reviews the slides? This is akin to saying that pathologists don't need any clinical history or data or understanding of diseases processes to make an accurate diagnosis. That would be insanity.

As for the claim that pathology knowledge is only important if you go into path or heme-onc, that is so laughable and ludicrous that it doesn't deserve a response. I am not saying everyone should know how to diagnose difficult cases of ulcerative colitis on biopsy, but a basic understanding of changes and pathology is crucial to learning and being an effective physician. If your goal is not really to be an effective physician, then go ahead and stop your learning, I won't argue.

I spent 2 years in Heme/Onc research... Path comes back fast enough that you can actually treat the patient, genotyping is nice, but in the majority of cases they aren't going to hold off induction chemotherapy to wait for it.

 

[DarksideAllstar]

1. I don't think I need to seek out experiences in emergency medicine that allow me to page pathologists to have a well-rounded education. All of my rotations have been at academic centers.

2. Wrong. Cancer diagnosis will continue to move towards genomics. Don't kid yourself, I've done Heme -- everyone gets a genotype.

3. It's only important to patient care if you go into Pathology or Heme/Onc.

Where did I ever say that you needed to page me to have a well-rounded education? I was providing an example of someone in the ED paging me, as you challenged another poster to do.

I won't elaborate on any more of this rubbish, as Yaah has hit points that I would have made. Your ignorance is showing, so I would suggest you stop posting about topics on which you know little to nothing about.

 

[DarksideAllstar]

This is part of the reason why students need to be taught more histo and pathology.

They don't need all that extra book learnin'-- look how smart we all are right out of med school. There's more important things to do with your med school years like changing foleys and fetching the team lunch!

 

[PeepshowJohnny]

Back to the original subject...one thing to consider is who's going to teach you molecular and cellular biology. All of this was integrated into our histology class. Sure we looked at pictures of tight junctions and such, but it also integrated teaching about intermediate fibers, microtubules, etc.

This stuff IS represented on Step 1 (probably more than throwing up a picture of normal liver histology and asking you to find the bile canaliculi, or asking you to pick out an eosinophil) so make sure you're getting it from somewhere.

 

[AmoryBlaine]

This is part of the reason why students need to be taught more histo and pathology. Presuming that genomics makes the diagnosis. Do you know how genomics is integrated into a diagnosis? You have to know where to start. You don't just throw blood or tumor tissue on a machine and randomly ask it what the diagnosis is - it gets evaluated and triaged and certain things are queried. And what you are suggesting is a remarkably inefficient and costly way to make any diagnosis. Genomics is coming more into play with tumors that are already diagnosed - looking for markers that indicate resistance/sensitivity to certain drugs, certain prognostic factors. It's basically worthless if you don't understand why you're ordering the test or it's ordered on the wrong specimen. As the years go forward, molecular techniques will add more and more to diagnostic and prognostic methods, but to suggest it is the panacea or the ultimate arbiter is pure ignorance.

Certain diagnoses (CML, some myeloproliferative disorders) are at or reaching the stage where some biopsy findings are basically irrelevant, but that is because morphology is so accurate and nearly diagnostic on peripheral blood, and the diseases are quite reproducible in their mutations. This is far from true from other diseases.

Someone made a comment about how all you need to know about pathology is to pick up the report, read the diagnosis, and then go act on it. As if understand the diagnosis and other things that go into making it (such as the limitations) were completely irrelevant. Have you ever been to a tumor board? Ever seen a diagnosis change when an expert reviews the slides? This is akin to saying that pathologists don't need any clinical history or data or understanding of diseases processes to make an accurate diagnosis. That would be insanity.

As for the claim that pathology knowledge is only important if you go into path or heme-onc, that is so laughable and ludicrous that it doesn't deserve a response. I am not saying everyone should know how to diagnose difficult cases of ulcerative colitis on biopsy, but a basic understanding of changes and pathology is crucial to learning and being an effective physician. If your goal is not really to be an effective physician, then go ahead and stop your learning, I won't argue.

No, no, no, no! The original discussion was about light microscopy and it's relevance to clinical practice. You are trying to pull a bait and switch and replace "pathophysiology" with "what pathologists do on a day-to-day basis."

Let me reiterate for those of you who are having such a difficult time understanding me: I am not saying pathology is useless or that it is not important. I AM saying that the technical skills of tissue diagnosis are completely useless for the average clinician.

It's so easy to say that histopath is vital for diseases that we know have very specific, colorful slides associated with them (MI, Heme malignancies, polypoid growths of the gut). But what about others? I have no idea what a cutaneous abscess looks like when sectioned but I can manage the heck out of it. Ditto a deep laceration. I don't know the histopathological changes associated with acute renal failure but I know indications for emergent dialysis. My challenge is to explain how the HISTOpath of these processes enhances my ability to treat/manage them. Don't try to put the word PATHOPHYSIOLOGY into my mouth.

 

[AmoryBlaine]

Where did I ever say that you needed to page me to have a well-rounded education? I was providing an example of someone in the ED paging me, as you challenged another poster to do.

I won't elaborate on any more of this rubbish, as Yaah has hit points that I would have made. Your ignorance is showing, so I would suggest you stop posting about topics on which you know little to nothing about.

What a silly post. You told me that I should find another medical center to rotate at...

You also said that looking at tissue slides was important for patient care. A completely bogus statemet unless, as I clearly said, you are a pathologist or a heme/onc doc. I might, might allow you that blood smears can be important but that is really more hematology than pathology.

What you (and others) are trying to do is basically to say, "I think my field is really cool therefore I think that anyone who doesn't know what I consider to be a sufficient amount of information about it to be lacking in vital knowledge." One could easily see how this could turn into a p***ing contest. I happen to be in emergency medicine, so I guess I can turn it around on you and say that if you don't know the basics of central line placement, lumbar puncture, complicated wound closure, and transvenous pacing that you are not a good pathologist.

I don't know much about histopathology and care less. Would you feel comfortable dropping an IJ on a criticaly ill patient?

 

[yaah]

No, no, no, no! The original discussion was about light microscopy and it's relevance to clinical practice. You are trying to pull a bait and switch and replace "pathophysiology" with "what pathologists do on a day-to-day basis."

Let me reiterate for those of you who are having such a difficult time understanding me: I am not saying pathology is useless or that it is not important. I AM saying that the technical skills of tissue diagnosis are completely useless for the average clinician.

It's so easy to say that histopath is vital for diseases that we know have very specific, colorful slides associated with them (MI, Heme malignancies, polypoid growths of the gut). But what about others? I have no idea what a cutaneous abscess looks like when sectioned but I can manage the heck out of it. Ditto a deep laceration. I don't know the histopathological changes associated with acute renal failure but I know indications for emergent dialysis. My challenge is to explain how the HISTOpath of these processes enhances my ability to treat/manage them. Don't try to put the word PATHOPHYSIOLOGY into my mouth.

Light microscopy is fundamental to the understanding of disease and pathophysiology. Knowing nothing about it diminishes your knowledge of these factors. The ideas are linked, despite what you think.

You use the IJ catheter analogy, it's almost akin to trying to understand how to put in an IJ catheter without knowing vascular anatomy. Anatomy is fundamental to understanding surgery and procedures, just as histopathology is fundamental to understanding pathophysiology. Asking me if I'm comfortable floating an IJ catheter is a distractor - I am not trained in that. You are not trained in histopathology therefore you wouldn't be trusted to make a diagnosis on a slide. But having a basic knowledge of it is important, just like I need to have a basic fundamental knowledge of IJ catheters, what they are used for, and what the complications of insertion (or bad insertion) are. Sure, you can put in an IJ catheter if you don't know where the veins go and what else is in the area, you might even become good at it. But you'll run into more problems and not know what to do about it if something goes wrong or is abnormal in a certain patient.

 

[AmoryBlaine]

Light microscopy is fundamental to the understanding of disease and pathophysiology. Knowing nothing about it diminishes your knowledge of these factors. The ideas are linked, despite what you think.

You use the IJ catheter analogy, it's almost akin to trying to understand how to put in an IJ catheter without knowing vascular anatomy. Anatomy is fundamental to understanding surgery and procedures, just as histopathology is fundamental to understanding pathophysiology. Asking me if I'm comfortable floating an IJ catheter is a distractor - I am not trained in that. You are not trained in histopathology therefore you wouldn't be trusted to make a diagnosis on a slide. But having a basic knowledge of it is important, just like I need to have a basic fundamental knowledge of IJ catheters, what they are used for, and what the complications of insertion (or bad insertion) are. Sure, you can put in an IJ catheter if you don't know where the veins go and what else is in the area, you might even become good at it. But you'll run into more problems and not know what to do about it if something goes wrong or is abnormal in a certain patient.

You only responded to 1/2 of my post...

Histopatholgy contributes almost nothing (zero) to an understanidng of pathophysiology.

1. You never responsed to my question: what about disease processes in which we never learn anything about histopath and yet still, remarkably, understand just fine? Examples include abscesses, lacerations, pneumonia, ligamentous injury, meningitis, sinusitis, atrial fibrillation, hyperkalemia, hyponatremia, headache, sepsis, mastitis, WPW, Down's syndrome, malabsorptive diarrhea, beri-ber, Dengue fever. Need I go on? You are harping on a small subset of diseases (heme stuff, cancers, certain inflammatory conditions) to make broad statements about how histo is vital for understanding pathophys.

2. One could easily imagine a little though experiment in which groups of students were given a certain group of slides to learn representing various solid tumors. Give group A the real deal and group B various sections of a goat testicle stained with different colors. Do we really think that group B is going to be left with a crippling lack of knowledge regarding sarcomas because in their mind they are imagining blue-stained goat sertoli cells?

 

[yaah]

You know what, man? I can't help you anymore. Go ahead and see things your way, it's not even worth arguing anymore. You're trying to argue that histopathology contributes zero to an understanding of pathophysiology in all instances except cancer and certain inflammatory conditions because it doesn't help us understand headaches and constitutional trisomies? Maybe we'll meet up again in the thread where you argue that it's pointless to learn pharmacology because all you have to know is that the drug works or not and what conditions you use it for.

 

[AmoryBlaine]

You know what, man? I can't help you anymore. Go ahead and see things your way, it's not even worth arguing anymore. You're trying to argue that histopathology contributes zero to an understanding of pathophysiology in all instances except cancer and certain inflammatory conditions because it doesn't help us understand headaches and constitutional trisomies? Maybe we'll meet up again in the thread where you argue that it's pointless to learn pharmacology because all you have to know is that the drug works or not and what conditions you use it for.

Instead of being dismissive why don't you try to answer the simple question? No one has given a concrete (or even decent) example of a) how histopath contributes meaningfully to understanding pathophys or b) how we manage to grasp pathophys of conditions for which we do not study histopath.

Pharm is not a good area in which to counterattack. Principles of bioavailability, time of onset to action, drug interaction, metabolism of drugs are bread and butter in almost every clinical specialties. Every time you consider dosage, route, side effects, contraindications etc you are dealing with basic pharm.

The converse is not true, when I am talking about someone with ischemic cardiomyopathy no one is imagining the slow march of PMNs, macrophages, and fibroblasts into dead myocardium -- it's just "dead heart, no pump."

 

[DarksideAllstar]

What a silly post. You told me that I should find another medical center to rotate at...

Comment made in response to your ******ed comment about the ED never calling a Pathologist.

You also said that looking at tissue slides was important for patient care. A completely bogus statemet unless, as I clearly said, you are a pathologist or a heme/onc doc. I might, might allow you that blood smears can be important but that is really more hematology than pathology.

Dude, ask any pulmonologist, nephrologist, GI/liver specialist, or oncologist how many times they look at H&E's. There is some histopath on their freakin boards! Being able to sit down and discuss findings with clinicians CAN BE VERY important to patient care and rendering the correct diagnosis. If histology isnt important, then why am I doing rush renal biopsies on Saturday morning for the kidney transplant service, who will change management based on what we say? Pull your head out of your ass.

What you (and others) are trying to do is basically to say, "I think my field is really cool therefore I think that anyone who doesn't know what I consider to be a sufficient amount of information about it to be lacking in vital knowledge." One could easily see how this could turn into a p***ing contest. I happen to be in emergency medicine, so I guess I can turn it around on you and say that if you don't know the basics of central line placement, lumbar puncture, complicated wound closure, and transvenous pacing that you are not a good pathologist.

I don't know much about histopathology and care less. Would you feel comfortable dropping an IJ on a criticaly ill patient?

Never said that anyone had to be an expert in anything that I did (read one of my above posts, it clearly states it). I was countering many of your assertions that histopathology has no role in patient care. And yeah, I've placed a bunch of central lines as a 3rd and 4th year med student-- who cares. I'm also ACLS certified (whoop-dee-doo). I've never once claimed to be all knowledgeable about ED algorithms and bedside procedures, yet you insist that you know so much about pathology and how it contributes to patient care (and its limitations). Maybe its less so in the ED (I'm not arguing that), but a pathologist is behind every goddamn CBC you order and CSF gram stain you request.

<yawn>. Are you finished yet?

BTW, I never wanna hear you call the lab asking about possible heterophile antibodies interfering with the troponin you got on the patient in bed 6.

 

[DoctorPardi]

I think the main argument here is as follows:
Amory: Knowing what a particular diseases looks like on a slide does not help most clinicians do anything
Yaah and others: Knowing something about histology is important to all physicians.

I don't actually think everyone is disagreeing, I just think there may be some miscommunication.

I tend to agree with both Yaah and Amory. Most doctors probably don't ever look in a microscope in their own practice, there is no reason too. So knowing what something looks like under a microscope is generally not helpful. At the same time we learn a lot of things in college, and throughout life we may not need at that exact time which are helpful at some point or just in developing as a human, student, or professional.

Medical school clearly is not a comprehensive tool for educating practicing physicians, as residency is obviously required. So in choosing a residency one must be at least somewhat familiar with all specialties for there to be any consistency. This familiarity with many different specialties must occur during medical school. The amount the regular practicing ER physician has learned in medical school about histology is very likely comparable to the amount a practicing pathologist has learned about central line placement. Histology in medical school is I am sure by no means comprehensive. The amount of "slides" Yaah can recognize or is familiar with would dwarf any 1st or 2nd year medical student's knowledge. Just as the skill in placing a central line of an ER physician is much greater than that of a 3rd year medical student.

 

[Occams Razor]

histology explains a lot, in my opinion.

i was born to be a pathologist, so i may be a little biased

 

[AmoryBlaine]

Comment made in response to your ******ed comment about the ED never calling a Pathologist.

Dude, ask any pulmonologist, nephrologist, GI/liver specialist, or oncologist how many times they look at H&E's. There is some histopath on their freakin boards! Being able to sit down and discuss findings with clinicians CAN BE VERY important to patient care and rendering the correct diagnosis. If histology isnt important, then why am I doing rush renal biopsies on Saturday morning for the kidney transplant service, who will change management based on what we say? Pull your head out of your ass.

Never said that anyone had to be an expert in anything that I did (read one of my above posts, it clearly states it). I was countering many of your assertions that histopathology has no role in patient care. And yeah, I've placed a bunch of central lines as a 3rd and 4th year med student-- who cares. I'm also ACLS certified (whoop-dee-doo). I've never once claimed to be all knowledgeable about ED algorithms and bedside procedures, yet you insist that you know so much about pathology and how it contributes to patient care (and its limitations). Maybe its less so in the ED (I'm not arguing that), but a pathologist is behind every goddamn CBC you order and CSF gram stain you request.

<yawn>. Are you finished yet?

BTW, I never wanna hear you call the lab asking about possible heterophile antibodies interfering with the troponin you got on the patient in bed 6.

1. You are doing a bait and switch, which is not unexpected. You are trying to say that the fact that certain clinicians look at slides is equivalent to something on those slides contributing meaningfully to the understanding of the disease process. When the renal fellow goes and looks at stuff with the pathologist, he is engaging in pattern recognition - comparing pictures of tissue to pictures he has seen before. This is diagnostics pure and simple and I have NEVER said that path does not have a role in diagnostics. We diagnose hyperkalemia by looking at a number, does that mean that having a detailed understanding of the way that a printer places ink on paper or a computer projects text onto a screen enhances our knowledge of hyperkalemia?

2. The original question was essentially "is histo important to understand path?" I have asked several appropriate questions against that position without getting answers. Instead you and yaah have been responding that a) pathologists make diagnoses (an assertion I have never challenged), b) that a few other specialties look at slides, and c) that pathologists routinely change clinical care (an assertion I have never challenged). In essence I am asking "do we really need to know this stuff?" and you are answering "pathologists are important!" When you don't answer direct challenges but instead say that I am ******ed you don't exactly enhance your argument.

2.5. Another thing that doesn't help your argument is when you make things up. You clamied that I asserted that EDs "never call pathologists." Here is what I actually said, "Please tell me, in some detail, about conversations you have had with EM physicians while on duty. While I don't doubt that they have occured, I take issue with your characterization of EM-path discussions happening 'all the time.'" Read posts carefully before you make unfounded accusations.

3. Again, we are talking about Histopath. I have been educated in one respect on this thread: I was honestly previously unaware of contact between pathologists and the emergency department. But the only thing you've been able to harp on is issues related to transfusional medicine which is a far cry from histopath.

 

[MSHell]

...No one has given a concrete (or even decent) example of a) how histopath contributes meaningfully to understanding pathophys ...

It's called Robbins.

Edit: Looks like you didn't read it. You should have. You'd have your answer. And not the mini Robbins in point form.

 

[ACSurgeon]

I think I only got 2 or 3 pure histo questions on Step I. Interpreting path slides was much more important.

However I think a strong histo foundation is very useful for learning pathology.

That would be my only concern. If your school teaches you enough pathology, then you porbably got enough histo along with it