Microscopic descriptions

[Deucedano]

Does anyone do them on all cases? I think its completely worthless in a vast majority of cases with the exception of a few. For some reason some of the people in my group say it provides some sort of legal protection. This makes zero sense to me. If you say you didnt see something and its there, how does that protect you? My attendings in residency (from a top 5 program) who did alot of legal cases said its a bad idea to avoid inconsistencies.

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[Alteran]

I only do them for certain types of cases or when I need to describe a difficult case, in which case the descriptors go into the comment. It's been my experience that either weak pathologists or those who have a tenuous position/contract routinely do them to "prove" their worth to patient care. Confident pathologists don't encumber themselves with such trivialities such as a microscopic description. They understand that the final diagnosis is the microscopic description.

Is your group forcing you to do microscopic descriptions on all cases?

 

[octopusprime]

Need to say you did one for billing, but don't have to go into detail. I only do it for melanocytic cases or to explain IHC/specials.

 

[Deucedano]

I completely agree. There also may be some perception of "value" which is also nonsense. Most clinicians dont read my comment when I tell them to.

No my group doesnt require me to do them. There are a handful of pathologists who do them and seem to be overwhelmed by the volume of cases at the practice which usually takes me 3-4 hours a day to do. They are trying to push to hire more people and its just insane to me.

 

[cmz]

I use micro descriptions in my comments sometimes or in the actual micro area -- typically reserved for neoplastic cases or unusual cases. Garden variety routines aren't worth my time to put a decent micro. Although, it probably isn't hard to create a canned comment for just about everything and include different variations of the microscopic. Still... too much work...

 

[ScubaV]

When I was a resident I had to do an outside rotation at a place that required microscopic descriptions on every case. It was actually kind of helpful at first. I can see some value in a training situation to force learners to think about a case methodically and identify key features with intention. Outside of that, the vast majority of clinicians don't care and only another pathologist who looks at your report later on will get anything out of it, which also only matters for those unusual cases.

 

[deleted314957]

No. Time is money. And the clinicians don’t read them or generally care to nor understand them. I will dictate PERTINENT comments when they are REQUIRED. Findings of generally accepted diagnostic significance are in the diagnosis. Having been on the clinical side and path side of this over the past few decades I came to appreciate “ enlightened brevity “.
An example of what I would consider a pertinent comment:
“Endoscopically, a mass with features of a malignant neoplasm was identified and biopsy was performed. Only unremarkable colonic mucosa is identified. Depending on the clinical presentation, further diagnostic studies may be useful”.
Also, unlike lots of rads, I almost NEVER forced their hands, ( they HATE that) thus the “depending on the clinical presentation “. The guy may be on deaths door and 98 y.o. I don’t know.

And, rather than useless, sterile descriptions, etc. my ace-in-the-hole came out when I would call the clinician. I called any malignancy when there was ANY diagnostic question from the clinical presentation. And THAT is where I would score hat trick after hat trick. You can easily make their day with the proper(and genuine) paeans to their acumen and abilities at that time. That is why I was there for 25+
years, solo.

 

[Guest8]

I do them for inflammatory derm, unusual tumors/melanocytic lesions, and anything unusual where the micro description explains how I arrived at my diagnosis. Otherwise I agree - the diagnosis IS the microscopic description. I don't need to microscopically describe BCC or tubular adenoma for anyone.

 

[WEBB PINKERTON]

You should always do microscopic descriptions on all cases and put images on all reports as well.

 

[SunBakedTrash]

I had some consult case from a corporate lab in Texas last week. It not only had photos, but also a microscopic description for each microscope slide ie “the section shows benign breast parenchyma and adipose tissue” on c22 of a mastectomy with a bunch of additional margins. Talk about what a sweatshop that place must be. The pathologists probably need a hall pass to take a leak.

 

[Dral]

I do them for inflammatory derm, unusual tumors/melanocytic lesions, and anything unusual where the micro description explains how I arrived at my diagnosis. Otherwise I agree - the diagnosis IS the microscopic description. I don't need to microscopically describe BCC or tubular adenoma for anyone.

Same here. It's a place to put things like immunostain results so I can bill for them...and I don't want to put them in the comment section since it's a 'tl;dr' situation for almost every clinician.