Stupid Pathologist Stories

[LADoc00]

Ill start off this thread, I had a chairman/boss who while proctoring me at my first faculty job out of training reprimand me for missing an "abscess" on my bone marrow core biopsy report. The supposed abscess was in fact a collection of mature/maturing normal neutrophilic precursors, needless to say I didnt stay at that butchershop for long!

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[Gut Shot]

I didn't witness this one, but it came from a reliable source.

One of the (now deceased) pathologists at my medical school pulled some slide trays from a resident's desk early one morning. They were some sort of cancer resection with lymph nodes (I want to say colon, perhaps breast). Anyways, he knew the family of the patient, so he read them and then called the patient/family to assure them that the margins were all clear and the lymph nodes were all negative.

Only problem is that there was another tray of lymph node slides that hadn't come out yet. Sure enough, some LN's where positive and it upstaged the whole mess. Oops.

The moral of this story is that to disrupt the normal work flow, for any reason, even if you think you're doing someone a personal favor, is asking for trouble.

 

[Zuwie]

This is a true story that the surgpath fellow told us happened at his program (not in my home city, thankfully).
A brand-new resident was grossing a colon resection for cancer on a Friday evening and could not find lymph nodes due to inexperience. She told that to the attending on Monday and the attending said: "If you didn't find the lymph nodes on Friday, you probably won't find them on Monday" and issued the final report that said "lymph nodes not identified." Of course, most read it to mean "lymph nodes negative" and assigned respective treatment. Two weeks later one of the surgeons reread the report and got its correct meaning. He literally ripped into the resident at the tumor board (like it was all her fault).
The colon specimen was dug out, ten lymph nodes were found and five of them were positive!

 

[djmd]

Two weeks later one of the surgeons reread the report and got its correct meaning. He literally ripped into the resident at the tumor board (like it was all her fault).
The colon specimen was dug out, ten lymph nodes were found and five of them were positive!

How is it not her fault? Was she not trained at all??
I mean it is not 100% her fault, the attending should have sent her back (or gone back with her).

Unless it was a sigmoid resection status post radiation... Those nodes are hella-hard to find...
And besides even if you can't find nodes, they will be easier to find after formalin fixation...

Anything less than 10-15 nodes at CCF and you will be sent back to the bucket at least twice. (usually with a senior resident or staff the second time)

 

[Zuwie]

How is it not her fault? Was she not trained at all??
I mean it is not 100% her fault, the attending should have sent her back (or gone back with her).

Unless it was a sigmoid resection status post radiation... Those nodes are hella-hard to find...
And besides even if you can't find nodes, they will be easier to find after formalin fixation...

Anything less than 10-15 nodes at CCF and you will be sent back to the bucket at least twice. (usually with a senior resident or staff the second time)

It certainly was partly her fault, but the attending shouldn't have said you can't find nodes three days later and then find them two weeks later.

 

[LADoc00]

This is a true story that the surgpath fellow told us happened at his program (not in my home city, thankfully).
A brand-new resident was grossing a colon resection for cancer on a Friday evening and could not find lymph nodes due to inexperience. She told that to the attending on Monday and the attending said: "If you didn't find the lymph nodes on Friday, you probably won't find them on Monday" and issued the final report that said "lymph nodes not identified." Of course, most read it to mean "lymph nodes negative" and assigned respective treatment. Two weeks later one of the surgeons reread the report and got its correct meaning. He literally ripped into the resident at the tumor board (like it was all her fault).
The colon specimen was dug out, ten lymph nodes were found and five of them were positive!

I have seen such nonsense, I can say now with my retroscope, that is ALL THE HEAD of the lame attending. That attending was being a lazy ass POS, plain and simple. The attending is ultimately responsible. Academic pathologists like that give all of us a bad name, hence I why I want to close down 50% at least of residency programs...they are swarming with incompetent lazy SOBs who couldnt survive 2 months in private practice. That easily is bad enough to go into an employee file especially considering the fallout with surgery.

 

[pathdawg]

I have seen such nonsense, I can say now with my retroscope, that is ALL THE HEAD of the lame attending. That attending was being a lazy ass POS, plain and simple. The attending is ultimately responsible. Academic pathologists like that give all of us a bad name, hence I why I want to close down 50% at least of residency programs...they are swarming with incompetent lazy SOBs who couldnt survive 2 months in private practice. That easily is bad enough to go into an employee file especially considering the fallout with surgery.

100% correct.

 

[pathdoc68]

I agree with the above posts - but I want to close down 50% of pathology residencies for another ( more selfish) reason. There are too many pathologists chasing too few jobs!! This is not the 1960's when there was no automation in pathology and half the pathologists were involved in doing the 1000-2000 autopsies per year that an average teaching hospital came by.

We need to seriously rethink training, I am not sure but maybe a CAP RF resolution should be proffered to see if we can explore the disconnect between the number of spots in training programs and the marketplaces ability to absorb graduates. The tight supply of Dermies is exactly why they make so much coin. Please anyone have thoughts on this?

 

[LADoc00]

I agree with the above posts - but I want to close down 50% of pathology residencies for another ( more selfish) reason. There are too many pathologists chasing too few jobs!! This is not the 1960's when there was no automation in pathology and half the pathologists were involved in doing the 1000-2000 autopsies per year that an average teaching hospital came by.

We need to seriously rethink training, I am not sure but maybe a CAP RF resolution should be proffered to see if we can explore the disconnect between the number of spots in training programs and the marketplaces ability to absorb graduates. The tight supply of Dermies is exactly why they make so much coin. Please anyone have thoughts on this?

Yep, there are WAY THE HELL too many trainees, pure and simple. I have said this time and time again, Ive told department chairs, surgpath chiefs and fellow trainees. Look for my other post as to why pathology training is such scam, dare I say "So dark the con of pathology"

 

[QuietSylph]

I agree with the above posts - but I want to close down 50% of pathology residencies for another ( more selfish) reason. There are too many pathologists chasing too few jobs!! This is not the 1960's when there was no automation in pathology and half the pathologists were involved in doing the 1000-2000 autopsies per year that an average teaching hospital came by.

We need to seriously rethink training, I am not sure but maybe a CAP RF resolution should be proffered to see if we can explore the disconnect between the number of spots in training programs and the marketplaces ability to absorb graduates. The tight supply of Dermies is exactly why they make so much coin. Please anyone have thoughts on this?

I agree too, though I know PDs all over the country would say "but we need this many residents - if not more - to staff the gross room, do the autopsies, etc." To solve that problem, I propose that radiology residents spend a year doing AP pathology instead of a year doing intern scutwork chasing labs and calling social services. Imagine the superior knowledge base they'd have going into radiology if they first did some surgical pathology, autopsy, and cytopathology... and then we wouldn't need as many pathology residents to cover our services.