pathologist personalities

[augmel]

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two questions,

1. i have heard that pathology is for those that really love the basic sciences. now i love understanding the logical processes by which disease happens and looking at slides and that stuff, but laundry lists of cytokines and following carbons in biochem make me shudder. how "basic sciencey" is real life pathology? how bout anatomic vs. clinical? are you all biochem junkies or what?

2. did most of you decide that patient care wasn't for you and then look to pathology or is pathology just so great that you will overlook not being able to see patients? (sorry to keep harping on this, i'm just trying to figure this out)

thanks for your opinions. this forum is so civilized and encouraging compared to some of the others. gives me a good feeling about the kind of people interested in path.

 

[Mindy]

Augmel:

I happened to do the post-sophomore fellowship in pathology essentially by accident. The coordinator of the program was trying to drum up interest, I needed a break from school, and I had a gut feeling I would like pathology. So she persuaded me to apply. I figured that understanding the basis of disease would help me become a better clinician.

What happened was an enormous struggle between what I thought I should do (take care of people directly) and what I found out I loved (pathology). So I guess I fall into the "pathology [is] just so great" group.

I really can only talk about AP, because that is what I spent my 12 months doing. Surgical pathology is a beautiful puzzle. You get a piece of tissue, you cut it up, you select pieces for close-up exam, and you then look at it under the scope trying to find clues about whether it is normal or not.

If identification of the tissue is not immediately evident (i.e. what type of tumor is it) you order special staining. This is where basic science understanding is most useful, however there are many written algorithms that are helpful. Different stains (as you know) stain different parts of tissues, aiding in identification. Classically: hematoxylin stains nucleic acids blue; eosin stains proteins (arginine and lysine) pink; and water, fat, & carbohydrates are colorless on H&E. Understanding the properties of different stains requires some biochemistry, but I found that just by using the stains I started understanding them.

Immunohistochemical staining uses flagged antibodies specific for certain cell proteins. Therefore you can identify tissues based upon what types of proteins they express. For example thyroglobulin antibody is useful in identifying thyroid tumors.

The latest wave in identifying/classifying tumors is molecular genetics. This is still a rather experimental area mostly because researchers are unsure of what each different DNA mutation actually means for a tumor in terms of prognosis, treatment, or importance to a patient. (For example, is it useful to know each of the hundreds of different mutations a colon cancer may have?) Eventually though this will probably be the future of pathology, and may become more important than morphology.

So, biochemistry is clearly important in pathology, however it is often used in an understandable (not terribly technical) way. Of course if you are involved in bench research you may need a more in depth knowledge.

BTW, I can't believe you can't get in on bench research without experience... THAT's RIDICULOUS... you're a med student for crying out loud... where are you s'posed to get the experience if not in med school?

Hopefully this long-winded (albeit enjoyable to write) response answers some of your questions in this and your other post.

Mindy

 

[GreatPumpkin]

I'm in the pathology is just so great I can do without patient contact camp myself. But, then again I get some patient contact.

 

[augmel]

thanks mindy,
the surgical path diagnostic puzzle is exactly what i love about path. the medicine-autopsy conference here is the intellectual highlight of my month. i enjoy learning the basic science stuff for the most part. it's just the endless detail (this amino acid binds to that amino acid causing a 14 degree shift in orientation....) that drives me crazy. i'm much more interested in the logical process that happens than in memorizing every cell surface protein and such.

i think i'm experiencing the same thing that you described dealing with earlier mindy. i have trouble picturing being a doctor but not being able to do medical missions or write a perscription for antibiotics if my kid gets sick on vacation. stupid little stuff like that. of course, being able to do that won't make up for not doing what i love day in, day out.

i guess i have no concept of what clinical path is. even when i worked in the path department of a community hospital, i never saw the pathologists do anything other than surgical path. so what is clinical path? is it just supervising the lab and deciding what tests to offer? is it more basic science oriented than anatomic path?

 

[augmel]

oh yeah,
and by the way, it's not a rule or anything that i couldn't do bench research. it's just that out of about 8 or 9 PI's that i talked to, none of them were willing to train me on running blots, pcr, etc. they all just seemed too busy and wanted people that had done the techniques before. unfortunately for me, there are LOTS of people here who do have the experience. can't blame the researchers for being busy, but i can blame the administration for making us do research and then not providing a way for us to learn bench techniques. leaves us non-science majors toiling in the damn chart rooms with agonizing piles of microfiche for our research. at least i'll still get great training in data analysis methods and getting stuff published.

 

[GreatPumpkin]

Pathologists can write prescriptions if they want to just like any other doc. Some of my fellow residents have done just that in instances similar to your example.

I have personally ordered medications for patients in house when seen in apheresis.

For info on clinical path check out the recent posts somewhere I described the different rotations. But, nothing beats personall exposure. You should try out a rotation if you can.

 

[blueintheface]

Hello path folks,

Nice summary of pathology, Mindy. "Pathology is a beautiful puzzle." How true! The art of pathology is being able to see each piece of the puzzle independently (cell morphology) and how they fit together (tissue architecture).

Augmel, regarding your other thread about basic science research, I don't think its so important to have bench research before applying for residency. PDs will know you are a MD, not a MD/PhD and therefore have little time to undertake a basic science project, much less get it to publication. A published case study on ALL would be very impressive in itself. If you think you might be interested in basic research, though, you should try to get your feet wet in a lab. I was in the same situation being a non-science major with no research background looking for a basic science project to work on. It took some legwork but I eventually found a lab that had a clinical offshoot from a basic science project. PIs are always looking for ways to make their basic research clinically relevant so you could leverage your clinical training. As minimal as your clinical knowledge is by second year, it is still more than most PhDs have.

So anyway, I guess I fall into the "love of basic science" group. Patient care, while occasionally gratifying, was mostly boring for me. I would rather follow around carbon atoms on a notepad than follow around my resident as he hunts for a misplaced xray.😛

 

[Mindy]

Augmel:

Similarly I am interested in medical missions, and was concerned that I could not do this as a pathologist. What I came to realize was that internationally pathologists are actually in short supply. I read one account of a pathologist in Africa who had to cover a several hundred mile radius by himself, reading slides every 2 or 3 weeks for the separate facilities. A surgeon I worked with also ran a small clinic in Haiti and said that specimens would be sent to Miami to be read once every few months. Another friend of mine told me that during a stint she did at an African Hospital, all specimens from the OR were thrown away. These stories make me think that the opportunity for medical missions is very possible as a pathologist.

 

[Mindy]

"I would rather follow around carbon atoms on a notepad than follow around my resident as he hunts for a misplaced xray."

Blue:

Nostalgia for the pre-adolescent ideals of doctorhood aside, I can't help but agree with this point!

Mindy