Survey of patients reveals interest in meeting pathologists

[Spikebd]

Cancer Patients Want to Pull Back the Curtain on Pathology

A Michigan Medicine survey reveals patients could feel more empowered and better understand their diagnosis after speaking directly with a pathologist.

labblog.uofmhealth.org

To me this is an interesting idea. I think we would do a better job explaining this stuff to patients than an oncologist or surgeon. With all of this pathologist oversupply discussion on this board, the field could use more work. Just bill these meetings like a psych HPI? Patient counseling meetings would also improve the visibility of this field.

This is another way digital slides would be helpful, as it would be easier to give a patient a presentation on a screen versus sitting at the scope with us.

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[Med Director New England]

I basically do this for free 2-3 x a month these days...old enough now to have many friends, family or Friends of family diagnosed with cancer or otherwise have something important within a path report.

it is kinda of fun actually and illustrative of how critical path input is to patient care.

 

[Gene_]

Better yet, let's figure out a way to teach oncologists enough pathology to explain the reports to patients.

 

[Napoleon1801]

Cancer Patients Want to Pull Back the Curtain on Pathology

A Michigan Medicine survey reveals patients could feel more empowered and better understand their diagnosis after speaking directly with a pathologist.

labblog.uofmhealth.org

To me this is an interesting idea. I think we would do a better job explaining this stuff to patients than an oncologist or surgeon. With all of this pathologist oversupply discussion on this board, the field could use more work. Just bill these meetings like a psych HPI? Patient counseling meetings would also improve the visibility of this field.

This is another way digital slides would be helpful, as it would be easier to give a patient a presentation on a screen versus sitting at the scope with us.

Certainly an interesting idea, but there are also some major squirrels in pathology that definitely should not see patients... I recall a number of very cringe-worthy FNA moments from training.

 

[WEBB PINKERTON]

Telepathology!

Doctor on Video Screen Told a Man He Was Near Death, Leaving Relatives Aghast (Published 2019)

A 78-year-old man with lung disease was told by a doctor on a streaming video that he did not have long to live, a strategy that his family saw as insensitive.

www.nytimes.com

 

[Spikebd]

Telepathology!

Doctor on Video Screen Told a Man He Was Near Death, Leaving Relatives Aghast (Published 2019)

A 78-year-old man with lung disease was told by a doctor on a streaming video that he did not have long to live, a strategy that his family saw as insensitive.

www.nytimes.com

Perhaps a one year fellowship would help residents develop these communication skills.

 

[caffeinegirl]

This has been advocated by CAP for years (Jennifer Hunt had several articles about it). However, billing is the big issue. There is no way to bill for these consultative services in the current scheme (how would you do an E&M encounter?, establish patient care and relationship, etc). And they take time and effort. And what is the liability involved? If it is done in a vacuum without a multidisciplinary effort, there are lots of hurdles to jump through. Right now, it seems that academic institutions are the only setting which this may be feasible.

Introducing patients to their pathology reports - CAP TODAY

January 2014—Meaningful use standards are fostering increasing patient access to medical records, including pathology reports. Yet pathology reports can be challenging even for clinicians, much less for patients, to understand. Nonetheless, it is typically left to the treating non-pathologist...

www.captodayonline.com

 

[MetroPath]

Do we really have the time to meet with families and sign iut

Certainly an interesting idea, but there are also some major squirrels in pathology that definitely should not see patients... I recall a number of very cringe-worthy FNA moments from training.

LOL I surely dont want some pathologists talking to my family, let alone care for them!

 

[y2k_free_radical]

This has been advocated by CAP for years (Jennifer Hunt had several articles about it). However, billing is the big issue. There is no way to bill for these consultative services in the current scheme (how would you do an E&M encounter?, establish patient care and relationship, etc). And they take time and effort. And what is the liability involved? If it is done in a vacuum without a multidisciplinary effort, there are lots of hurdles to jump through. Right now, it seems that academic institutions are the only setting which this may be feasible.

Introducing patients to their pathology reports - CAP TODAY

January 2014—Meaningful use standards are fostering increasing patient access to medical records, including pathology reports. Yet pathology reports can be challenging even for clinicians, much less for patients, to understand. Nonetheless, it is typically left to the treating non-pathologist...

www.captodayonline.com

I'm sure MEDICARE,MEDICAID and private insurers will willingly and gladly pay us for our time

 

[Spikebd]

This has been advocated by CAP for years (Jennifer Hunt had several articles about it). However, billing is the big issue. There is no way to bill for these consultative services in the current scheme (how would you do an E&M encounter?, establish patient care and relationship, etc). And they take time and effort. And what is the liability involved? If it is done in a vacuum without a multidisciplinary effort, there are lots of hurdles to jump through. Right now, it seems that academic institutions are the only setting which this may be feasible.

Introducing patients to their pathology reports - CAP TODAY

January 2014—Meaningful use standards are fostering increasing patient access to medical records, including pathology reports. Yet pathology reports can be challenging even for clinicians, much less for patients, to understand. Nonetheless, it is typically left to the treating non-pathologist...

www.captodayonline.com

What If our discussions with patients and their families dazzle them so much that a hospital patient satisfaction scores improve? What if outcomes and length of stay are improved? Would we then be allowed compensation for our time?

 

[caffeinegirl]

What If our discussions with patients and their families dazzle them so much that a hospital patient satisfaction scores improve? What if outcomes and length of stay are improved? Would we then be allowed compensation for our time?

Good luck with that. Most hospital contracts don't take any of these into account, and the hospital admin only cares about the bottom line ($). The only way to actually be compensated for this is to have a CPT code or encounter billing code. The hospital will likely not "by its good graces" give you any compensation for this type of work. They already pay a pittance for medical/laboratory director fees.

 

[Spikebd]

Good luck with that. Most hospital contracts don't take any of these into account, and the hospital admin only cares about the bottom line ($). The only way to actually be compensated for this is to have a CPT code or encounter billing code. The hospital will likely not "by its good graces" give you any compensation for this type of work. They already pay a pittance for medical/laboratory director fees.

So the only way to fill this demand would be to run some sort of boutique pathology consult service where you sit down with the patient and have them bring their slides to us for a “pathologist to patient sign out”? Charging a fee to stage IV patients seems somewhat cruel.
And I can imagine some of us being much better at this type of thing than others. It’s almost like hospice work.

 

[y2k_free_radical]

So the only way to fill this demand would be to run some sort of boutique pathology consult service where you sit down with the patient and have them bring their slides to us for a “pathologist to patient sign out”? Charging a fee to stage IV patients seems somewhat cruel.
And I can imagine some of us being much better at this type of thing than others. It’s almost like hospice work.

Oncologists,radiation therapists, surgeons and hospice physicians do.

 

[chooks]

CFR 42 SS 42 CFR § 493.1445 - Standard; Laboratory director responsibilities

...(9) Ensure that consultation is available to the laboratory's clients on matters relating to the quality of the test results reported and their interpretation concerning specific patient conditions;

You could argue that patient consults falls under Part A medical laboratory director responsibilities (although parsing of "laboratory clients" may be malleable) and reimbursable under that.

 

[LADoc00]

This is totally hair brained in a forum filled with really hair brained stuff. Having people sit down with me when I make 10000 diagnoses in a year and having me explain stuff is something of almost Rick and Morty level of shenanigans.

First off, I will ABSOLUTELY be monetizing this. Like Platinum service or something. It will be crazy too, like 1000/hr. Maybe more.

So sure, for that ultrawealthy patient who is REALLY interested in their disease, could be an option.

Definitely keep these GEM ideas coming folks.

 

[cmz]

This is totally hair brained in a forum filled with really hair brained stuff. Having people sit down with me when I make 10000 diagnoses in a year and having me explain stuff is something of almost Rick and Morty level of shenanigans.

First off, I will ABSOLUTELY be monetizing this. Like Platinum service or something. It will be crazy too, like 1000/hr. Maybe more.

So sure, for that ultrawealthy patient who is REALLY interested in their disease, could be an option.

Definitely keep these GEM ideas coming folks.

So that's how a plumbus is made...

 

[Unty]

This is totally hair brained in a forum filled with really hair brained stuff. Having people sit down with me when I make 10000 diagnoses in a year and having me explain stuff is something of almost Rick and Morty level of shenanigans.

First off, I will ABSOLUTELY be monetizing this. Like Platinum service or something. It will be crazy too, like 1000/hr. Maybe more.

So sure, for that ultrawealthy patient who is REALLY interested in their disease, could be an option.

Definitely keep these GEM ideas coming folks.

Yup which pathologist is going to have time to sit and discuss findings with a patient which I can see lasting one hour when you have trays of slides to look at.

I can see it only happening in academics where folks have off clinical days.

 

[rirriri]

This is totally hair brained in a forum filled with really hair brained stuff. Having people sit down with me when I make 10000 diagnoses in a year and having me explain stuff is something of almost Rick and Morty level of shenanigans.

First off, I will ABSOLUTELY be monetizing this. Like Platinum service or something. It will be crazy too, like 1000/hr. Maybe more.

So sure, for that ultrawealthy patient who is REALLY interested in their disease, could be an option.

Definitely keep these GEM ideas coming folks.

it’s not meant for every patient.

patient conversations apply to difficult cases which are often malignant. Some patients are very involved in their care and benefit greatly from these conversations. I have had many and it was a great experience for myself but more importantly for the patient’s understanding and care.

parhologists getting involved in patient care is a great step forward for the field. Not everything has to do with $$$ some things are about cultural shifts which are vastly more
Important than short term reimbursement, IMO. Investing in the culture means greater rewards in the future along with higher reimbursement potential and respect from patients and other specialties.

 

[LADoc00]

it’s not meant for every patient.

patient conversations apply to difficult cases which are often malignant. Some patients are very involved in their care and benefit greatly from these conversations. I have had many and it was a great experience for myself but more importantly for the patient’s understanding and care.

parhologists getting involved in patient care is a great step forward for the field. Not everything has to do with $$$ some things are about cultural shifts which are vastly more
Important than short term reimbursement, IMO. Investing in the culture means greater rewards in the future along with higher reimbursement potential and respect from patients and other specialties.

No by all means go and do this YOURSELF. When you are huffing paint under a bridge because you went broke because "not everything has to do with $$$" tell me how that feels. I want you to head to a public library somewhere to get warm and post up on SDN 10 years from now when you are living part time in a homeless shelter and spending afternoons picking scabies mites off your arms.

Investing in "Culture" sounds like something Mao Zedong would say so Im going to out on the limb to say you are likely Chinese or Chinese ethnic origin.

Let me give you explains of "Investing in Culture" and making sacrifices:
1.) Turkish culture: Armenian Genocide 1.5m dead
2.) German culture: 12m dead
3.) Mao's investment in Chinese culture: 30m dead
4.) Stalin's investment in Slavic culture: 50m dead
5.) America's investment in English culture: 130m dead

The only way pathology practices can operate is throughput efficiency, without that the entire system collapses.

A random one off patient interaction is immaterial, a steady stream of people asking questions is a doomhammer.

You lack the skills to cogently sell your ideas here ON SDN, how can you possibly imagine you have ANY of the necessary skills to interact in a volatile setting with highly charged family members while you are telling them something bad with no knowledge of any treatment options to offer hope at the same time.

Our system is built a certain way in medicine because people FAR FAR wiser than you and smarter than you came before you to lay a template so disregard that template at your own risk all you SDN readers.

 

[Unty]

Yes ririri lives in academia she has the mindset of an academic (nothing wrong with that).

 

[Nilf]

Cancer Patients Want to Pull Back the Curtain on Pathology

A Michigan Medicine survey reveals patients could feel more empowered and better understand their diagnosis after speaking directly with a pathologist.

labblog.uofmhealth.org

To me this is an interesting idea. I think we would do a better job explaining this stuff to patients than an oncologist or surgeon. With all of this pathologist oversupply discussion on this board, the field could use more work. Just bill these meetings like a psych HPI? Patient counseling meetings would also improve the visibility of this field.

This is another way digital slides would be helpful, as it would be easier to give a patient a presentation on a screen versus sitting at the scope with us.

This is not a bad idea in theory, but nearly impossible to carry out in practice. Radiologists do it, and they bill for that. However it's been talked about at least for 10 years and nothing has changed. I remember this was actually discussed on this forum many years ago.

I have heard about this idea last decade during residency from the leader of a major pathology organization who came to lecture about the subject. He was arguing that pathologists should get closer to the 'bedside' to stay more relevant and visible. The audience was sceptical to say the least.

To sum up, first we would have to figure out how to get paid for such consultations.

 

[yaah]

Surveys like this are often kind of loaded questions, "would you like to meet with the person who actually made the diagnosis that changed your life forever?" An awful lot of people would say yes to that question even if they don't really care. I will meet or talk to patients if they want, typically most of them are hospital or lab employees who have some knowledge of the system. I also give occasional talks to patient groups like survivor groups, but a lot of times they just have specific questions about what specific words mean or things like that. Patients from outside are typically not as informed.

 

[Guest8]

There's no reason we should not be compensated for a meeting like this. If you want to meet with your oncologist you schedule an appointment and they bill for it. Same with your surgeon. Same with your PCP. Same with any other doc. There's no reason we should not be able to bill for what amounts to direct patient care/consultation.

 

[LADoc00]

Surveys like this are often kind of loaded questions, "would you like to meet with the person who actually made the diagnosis that changed your life forever?" An awful lot of people would say yes to that question even if they don't really care.

Of course. You can even poll that data to show people want to meet their specimen couriers, histotechs, hospital IT specialists etc depending on how you worded the question. It's laughably naive to imagine as a profession we are situated to do this on any mass scale EVEN if it was paid for activity.

 

[yaah]

It reminds me of the survey that the USMLE put out when it was trying to convince people that step IIcs was a good idea. They commissioned a survey of non-doctors and asked a question like, "Don't you think it would be a good idea for medical school graduates to have to pass a test demonstrating they can communicate effectively with patients and perform a physical exam?"