To what extent can pathologists perform clinical exams (e.g. when volunteering) ?

[monopolova]

---

Members don't see this ad.

I am really interested in pathology. The thought of never being able to use a stethoscope ever again pains me, though, and I have heard differing things from different people concerning whether or not a pathologist can volunteer in a free clinic, for example, and perform basic clinical exams like those that we spend our third and four years learning to do. I'd really like to be able to volunteer and maintain some clinical skills while pursuing my pathology career. It kind of seems outlandish that medical students would have more freedom than a pathologist when it comes to performing a physical exam, especially considering the breadth of knowledge a pathologist could bring to a clinical scenario.

Thanks.

 

[deschutes]

See recent discussion here:

http://forums.studentdoctor.net/showthread.php?t=281138

I would also venture to say it isn't just the challenge of keeping up one's clinical skills, but as an MD one is infinitely more liable in the event of a misdiagnosis compared to a medical student.

 

[Gene_]

I am really interested in pathology. The thought of never being able to use a stethoscope ever again pains me, though, and I have heard differing things from different people concerning whether or not a pathologist can volunteer in a free clinic, for example, and perform basic clinical exams like those that we spend our third and four years learning to do. I'd really like to be able to volunteer and maintain some clinical skills while pursuing my pathology career. It kind of seems outlandish that medical students would have more freedom than a pathologist when it comes to performing a physical exam, especially considering the breadth of knowledge a pathologist could bring to a clinical scenario.

Thanks.

If you're interested in clinical work, are you considering doing a transitional year to polish up your clinical skills?

 

[Anna Plastic]

Pathology isn't entirely without patient contact. Cytopath/FNA has the barest trace of it (hey, you *are* putting your hands on the patient, if only to localize the lump and stick a needle in it). But other areas, such as transfusion medicine, can have more physical exam opportunities (or responsibilities, depending on your view). If you are writing orders for pheresis procedures (and getting compensated), you perform physical exams on the patients. During my training as a transfusion medicine fellow, I've gone around to outpatient clinics and inpatient rounds, and done physicals/written notes, as well as frequently going into O.R.s to talk with surgeons, anesthesiologists, etc. I'm not sure if any other clinical pathology types (like microbiologists) go on rounds and take time to see patients--has anyone out there seen this? I certainly suspect this would be happening more in academic practice than in private practice.

 

[SLUsagar]

I am really interested in pathology. The thought of never being able to use a stethoscope ever again pains me, though, and I have heard differing things from different people concerning whether or not a pathologist can volunteer in a free clinic, for example, and perform basic clinical exams like those that we spend our third and four years learning to do. I'd really like to be able to volunteer and maintain some clinical skills while pursuing my pathology career. It kind of seems outlandish that medical students would have more freedom than a pathologist when it comes to performing a physical exam, especially considering the breadth of knowledge a pathologist could bring to a clinical scenario.

Thanks.

can't over-emphasis good physical exam technique for cytopath. It's key b/c YOU actually get to feel the lesion that you later look at under the scope to find tumor etc...
i.e. you get quite good at recognizing tumor etc by physical exam.

 

[monopolova]

Thanks for the replies all. I was really asking what the link to which I was referred was asking, though no conclusive reply was given in that thread. To be more specific about it, the question is one of legality, namely, "as a pathologist, if I work in a free clinic and perform general physicals on people am I breaking the law since I haven't technically finished a residency in internal medicine or family practice, for example".

I like the idea given of doing a transitional period to more officially get these skills if that's necessary. Maybe there's a fellowship or something that one can do for the interest of ensuring that one's clinical skills are not only up to par, but legally fit for practice.

Thanks all.

 

[monopolova]

When I think further about it, one begs the question of what a person just exiting from medical school is legally allowed to do (clinically that is) ... my guess has always been "nothing".

 

[india7]

i've had the same question and did get some good ideas in a previous thread. i am curious still though about this, as a pathologist is it feasible to do community volunteer clinical med. sorry, no answers, just support for the question!

 

[Leukocyte]

i am curious still though about this, as a pathologist is it feasible to do community volunteer clinical med.

Malpractice law suits.....a BIG concern.

-When a Surgeon sees signs of HTN, he sends the pt to Medicine.

-When an Ophthalmologist sees diabetic retinopathy, she sends the pt to Medicine.

-When a Trauma Surgeon gets a pregnant patient, he will call OB/GYN, if there is time and if there is one available, to do the emergency c-section.

-Most docs can read their own films (within their speciality), but still prefer to hear the Radiologist's opinion.

No doctor likes to do things outside their specialty if they do not HAVE to....for fear of law suits.

The answer to your question is Yes, if you are willing to take the risk.

 

[Gene_]

When I think further about it, one begs the question of what a person just exiting from medical school is legally allowed to do (clinically that is) ... my guess has always been "nothing".

You're right. Recent graduates have a medical degree, but not a license to practice medicine. Once you have a license, you can legally see patients. I doubt that it would be wise, though, unless that pathologist has lots of clinical experience (ie. was a primary care physician before doing a pathology residency).

Some states protect physicians working in free clinics. In Texas, a physician working in a free clinic is protected from lawsuits by good samaritan laws. But, regardless of legal issues, it would still be unethical to deliver incompetent medical care to those patients. IMO, anyone without at least an intern year (not a pathology pgy-1 year) is incompetent to staff a free clinic.

 

[Aubrey]

i've had the same question and did get some good ideas in a previous thread. i am curious still though about this, as a pathologist is it feasible to do community volunteer clinical med. sorry, no answers, just support for the question!

Well, unless you absolutely crave the intense drama of being "on the front line" with your stethoscope and Hemoccult card in hand, I'm sure there would be oodles of free clinics, etc. that wouldn't mind having a pro bono pathologist around from time to time (peripheral smear interpretations, doing FNAs, looking at slides on a consult basis).

 

[Aubrey]

As another aside, in most states, when you receive your unrestricted medical license, it is just that.. unrestricted. In Virginia, our licenses are for "Medicine & Surgery," with no subspecialty distinctions. So, a FP could theoretically go and do a Whipple on their day off, even though it would be grossly inappropriate and dangerous, and such a doc would (rightly) be sued back to the Stone Age. So if you have an unrestricted medical license, I would _think_ that you would probably be legally able to practice in a free clinic volunteer setting, but that sure as heck doesn't mean that you should.

 

[Leukocyte]

Some states protect physicians working in free clinics. In Texas, a physician working in a free clinic is protected from lawsuits by good samaritan laws.

As far as I know, in Wisconsin the Good Samaritan law does not protect a "good Samaritan" who identifies himself as a licensed physician.

So if a physician drove by a car accident (in Wisconsin) and decided to help, then he is protected by the Good Samaritan law, as long as he never mentions that he is a physician.

 

[ilovepath]

sounds like an anti anti clinical medicine thread. personally, once i get my md my stethescope will be destroyed in some creative way. either that or be donated to the spirit of truth

 

[pathdawg]

I am really interested in pathology. The thought of never being able to use a stethoscope ever again pains me, though, and I have heard differing things from different people concerning whether or not a pathologist can volunteer in a free clinic, for example, and perform basic clinical exams like those that we spend our third and four years learning to do. I'd really like to be able to volunteer and maintain some clinical skills while pursuing my pathology career. It kind of seems outlandish that medical students would have more freedom than a pathologist when it comes to performing a physical exam, especially considering the breadth of knowledge a pathologist could bring to a clinical scenario.

Thanks.

If patient contact is a priority to you to the point that you would consider volunteering at a free clinic, then I strongly feel that you should go into clinical medicine. As a physician, pathologist, and attending, I think one of the most important (and hardest) things to learn is your own limitations. I respect how difficult clinical medicine is (I did a year of internal medicine before my path residency). I therefore would not presume that after five years of pathology training that I could just step in and perform physical examinations and other clinical duties on patients. I would not be doing the patients or myself a service. I leave clinical medicine to those properly trained in that field. Simply graduating from medical school does not qualify one as a clinician. If only clinical medicine were that easy. I have seen people who are pathology-trained who feel that they could indeed just step in and do clinical work. Frankly, they are naive and uninformed.

Medicine in general can be summed up in two words: Harsh Reality. The harsh reality here is that there is no real patient contact in pathology. A pathologist who thinks he or she can function as a clinician is both doing their patients a disservice and exposing themselves to medical malpractice litigation. If your career dream involves taking care of clinic patients, then do a family practice residency. No disrespect intended. Just my two cents.

 

[monopolova]

If patient contact is a priority to you to the point that you would consider volunteering at a free clinic, then I strongly feel that you should go into clinical medicine. As a physician, pathologist, and attending, I think one of the most important (and hardest) things to learn is your own limitations. I respect how difficult clinical medicine is (I did a year of internal medicine before my path residency). I therefore would not presume that after five years of pathology training that I could just step in and perform physical examinations and other clinical duties on patients. I would not be doing the patients or myself a service. I leave clinical medicine to those properly trained in that field. Simply graduating from medical school does not qualify one as a clinician. If only clinical medicine were that easy. I have seen people who are pathology-trained who feel that they could indeed just step in and do clinical work. Frankly, they are naive and uninformed.

Medicine in general can be summed up in two words: Harsh Reality. The harsh reality here is that there is no real patient contact in pathology. A pathologist who thinks he or she can function as a clinician is both doing their patients a disservice and exposing themselves to medical malpractice litigation. If your career dream involves taking care of clinic patients, then do a family practice residency. No disrespect intended. Just my two cents.

Thank you all for the great responses. I agree with the ultimate conclusion, namely that if I am that interested in clinical medicine, I should become a clinical doc. I just kinda wanted to have my cake and eat it, too, but you're right in saying sometimes you just have to pick and choose. I'm not anti-anti-clinical medicine. I'm just kind of really undecided. I love the idea of being a pathologist because I just love what it brings to the table. I love the idea of being the one who actually makes the news rather than simply delivers it. At the same time, it's kind of sad to me to learn so many great things about patient care never to use that again, even in one's free time. I guess that when the time comes, I'll have to make an ultimate decision and live with it.

Thanks again everyone.

 

[india7]

thank you also for all the thoughts, this was very, very helpful. i really like the idea of offering services as a "pro-bono" path at free clinics. maybe i'm being too naive, but that seems like a great avenue to stay connected with free clinics yet not work outside our area. thanks again....india.