PITA

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musom

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I just finished a right hemicolectomy with two enormous friable TVAs. Of course I had to submit all the blasted things so very carefully after good fixation and paddle forceps. Then I soak the fat in picric acid for a day to delve into the joys of lymph node retrieval, in which I go through a half dozen blades and 8 pairs of gloves as the picrate dissolves my gloves and then fingernails secondary to the cheap-ass hospital issued gloves I'm told to use. And nothing more exciting that looking through 41 blocks of tissue to decide on TVA w/ HGD versus intramucosal adenoCA, and then paying attention to all 26 lymph nodes I found.

So I poll the audience, what is your least favorite specimen?
 
Large ENT composite resections. I only encountered them as resident/
attending in Navy. Didn’t have them in my community hospital
practice thank God.
 
I hate melanocytic lesions and inflammatory skin lesions. Dermpath is beyond boring to me.
 
mikesheree said:
Large ENT composite resections. I only encountered them as resident/
attending in Navy. Didn’t have them in my community hospital
practice thank God.
Click to expand...

I second this one - in residency we had lots of them. They were often a huge pain. We called them face-ectomies. Thankfully I don't have to gross much anymore and we don't get face-ectomies where I am now. On a side note - what percentage of pathologists gross the majority of their specimens? This seems like a huge waste of time (and money) to me. Some places I've interviewed the pathologists gross all their cases (no PA) - I though it was kind of silly. I thought "don't hire me, hire a PA for a fraction of what you'd pay me." Of course I didn't say that but it was a real factor in not pursuing said job. I grossed enough placentas in residency to last the rest of my life.
 
There's very little, if any option in rural parts. Admin thinks "why hire a 60k PA when we have a capable pathologist that can do the grossing himself". Even if I could convince admin to pursue hiring a PA, there's no way in hell I could convince one to come based on "what the town has to offer". Also, we don't do autopsies and have a volume of about 6k cases/yr, so that's about 2 hours (on a bad day) of grossing. What's the PA gonna do for the other six hours, file blocks? I wish it made more sense, but I still work at 8-hour day with that volume without a PA. I've also trained the HTs to gross the smalls for me. Huge benefit.
 
musom said:
There's very little, if any option in rural parts. Admin thinks "why hire a 60k PA when we have a capable pathologist that can do the grossing himself". Even if I could convince admin to pursue hiring a PA, there's no way in hell I could convince one to come based on "what the town has to offer". Also, we don't do autopsies and have a volume of about 6k cases/yr, so that's about 2 hours (on a bad day) of grossing. What's the PA gonna do for the other six hours, file blocks? I wish it made more sense, but I still work at 8-hour day with that volume without a PA. I've also trained the HTs to gross the smalls for me. Huge benefit.
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That all makes good sense. I guess a place with volume under ~15 or 20k probably can't justify having a PA. Do you think doing the grossing yourself makes signing out the cases the next day easier?
 
Not considering the workload. Gallbags, hernia sacs, GI stuff and some ENT sprinkled here and there is about all. I rarely get a specimen that would require "expert" grossing skills.
 
SEpathguy said:
That all makes good sense. I guess a place with volume under ~15 or 20k probably can't justify having a PA. Do you think doing the grossing yourself makes signing out the cases the next day easier?
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i have worked in a remote, crime ridden yet high volume center with 25000 cases a year and the pathologists did the grossing because no PA would move to this place.

its sad to think that PAs are harder to get than pathologists.
 
add a well-trained cytotech to that last as well. Hell, it took me more than two years to find a qualified HT to help out.
 
You hear from time to time, especially at cytopath meetings, the desire to create a mid-level in pathology. They need to create workers that can gross, use a microtome and handle cytology. The smaller operations might be able to condone hiring someone with all those skills. Right now PA and cytology are too specialized and you need a large volume to hire either one. So we are stuck grossing and screening the dwindling cytology specimens. I will never understand why they haven't combined PA and cyto screeners into one profession.
 
3mm punch bx with clinical history "rash"
 
SEpathguy said:
That all makes good sense. I guess a place with volume under ~15 or 20k probably can't justify having a PA. Do you think doing the grossing yourself makes signing out the cases the next day easier?
Click to expand...

I feel that examining a specimen and submitting the sections helps me to better understand what I'm looking at underneath the microscope. This is especially the case when I'm looking at a close margin, or trying to guess if I'm looking at floaters or other artifacts.

Of course, I'm talking about resections, not biopsies. There is zero benefit to grossing those.
 
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