subspecialty?

[augmel]

i'm curious what subspecialties are interesting to people. dermpath obviously appeals to some folks, but is that for reasons other then the big money? (don't mean to offend, just the impression i've got) GP, what are you going to do for the dang 5th year you got? neuropath seems really cool, but kinda useless for the non-academically inclined. renal seems the same way. what are all you path docs (and very soon to be) thinking about?

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[Global Disrobal]

After the post soph, I liked

GI Path and Soft-Tissue/Bone

Dermpath was awesome too, especiallt the medical dermpath which is lesions other than the melanocytic ones (i.e. allergic, histiocytosis, etc.)

 

[augmel]

something else i've wondered for those in the know. do cytopath docs stick the needle and say adios or do they often tell the patient their diagnosis themselves? when i was a path tech, i'm pretty sure i remember some of the docs going back down to talk to the patient after they did their touch-preps and such to let them know what they found. this seems like kind of an important patient contact, which made me wonder if this was unusual. do the path folks usually just send a report to the referring doc and let them break the news?

 

[augmel]

hi GD,
i'm not sure i understand the distinction. is medical dermpath just any non-melanocytic bx specimen? do they really do bx's of allergic lesions?

 

[Global Disrobal]

I worked with several very good Dermatopath people when I was doing the PSF and their consensus was that med dermpath (term loosely applied) was were you could distinguish the good dermpaths from the great ones.

With melanocytic lesions (in addition to basal cells and couple of other bread and butter lesions) you can generally (not always, like desmoplastic melanoma) use certain guidelines and resources to make the call.

With medical cases, such as odd forms of rash, or whatever clinical presentation you can think of...you can get slides where the diagnosis is not straight forward, lots of clinical knowledge is needed and often special stains are of no use. Alot of times little intricate details were what the pathologist used to nail the diagnosis.

That is basically how they distinguished the subparts of dermpath. Now keep in mind this was what I was told by people at one program, and it may be different elsewhere.

 

[rirriri]

Originally posted by augmel
something else i've wondered for those in the know. do cytopath docs stick the needle and say adios or do they often tell the patient their diagnosis themselves? when i was a path tech, i'm pretty sure i remember some of the docs going back down to talk to the patient after they did their touch-preps and such to let them know what they found. this seems like kind of an important patient contact, which made me wonder if this was unusual. do the path folks usually just send a report to the referring doc and let them break the news?

augmel,

ive often wondered why this wasn't done more than it is. I always imagined myself doing this and "revolutionizing" pathology into a new realm of interaction within the hospital. It is encouraging to hear that you worked with Pathologists who have been doing it already.

GP may know more about this, but from what i know, this is not a common practice. I know that Pathologists go to speak with the physicians, but i rarely hear of them talking to the patient.

(don't get me wrong, im not looking for excessive patient contact, but i think it adds another dimension to the job which may be desirable. and obviously the pathologist can choose whether he/she wants to do this or not)

cheers!!

 

[GreatPumpkin]

Well GP is in the last class that is required to do a 5th year. So no 5th year fellowship for me. Well actually i will get a certificate for completing a surgical pathology fellowship for my 5th year. There is no board required for a surg path fellowship, so I can do that. But, after that I am looking for a job. I am sick of being poor and I am in big time debt, hehe. I want to go to a small hospital practice so I don't really need a fellowship to find work. Also, people that grad from my program get about 5 times more cytology than most so we are considered very highly in the job market. And, we have some big names in the cyto field. Everyone in my program has an open offer if I want to go to northern Louisiana and do cytology......hehe, not likely I am going there though. Too hot and I need the ocean. I am thinking Chesapeake Bay area or Maine. Maybe out West near the ocean.

My favorite area is soft tissue and bone. The specimens we get in these areas are always so interesting and always a puzzle it seems. Seems like we are always pulling out the xrays, talking them over with the ortho guy and pondering over them for much longer than anything else. And, normally we have FNA slides that go with the case too. So the learning experience is very high.

Cytopath docs normally call back the results to the doc who ordered the consult. They are the ones that really have the patient-doctor relationship. When you go down to do the FNA (fine needle aspirate) you really don't get much time to form that bond. Maybe it is done differently other places, but that is pretty much how it is here. Same goes for pathologist who do bone marrow biopsies.

 

[augmel]

thanks for the posts folks,

rirriri,
i've kinda thought the same thing. it would be a neat way to feel the impact of your work. still, there are problems and i'm undecided whether or not it is appropriate.

GP,
you and GD both said you like the bone-soft tissue stuff. i was looking at a text and it had a lot more radiology and surgical correlation than most the books i've seen. that seems really what pathology is about, rather than slapping colon bx after colon bx under the microscope. puzzling through a problem. i'll have to look more into that stuff cause it is probably the kind of path i would least recognize.

anyone else think about subspecialties? just curious what people think, so you don't have to know whether you would actually pursue it to offer an opinion.

 

[augmel]

bumpah