Making the connection between the pathologist and the patient
By Brinda Rodrigues Kamat, M.D., M.P.H.
Television has likely done more than anything else to put the medical specialty of pathology before the American public. Programs like Quincy, M.E. (for the older among us; it ran from 1976-1983) and the current hit CSI have given millions of people an inside look at pathology and forensic science in the pursuit of solving crimes.
One show, Medical Investigation, which ran but one season 2004-2005, even featured pathologists as its main characters. According to tv.com, the show's stars were "members of a mobile medical team from the National Institutes of Health who are summoned in a heartbeat to scope out and hopefully snuff out outbreaks of unexplained and fearful diseases. These specialists drop out of the sky anywhere and have government carte blanche to take charge when people start dying, which requires them to medically re-construct grisly events to prevent the next epidemic, plague or contagion."
Wow. That's entertainment. In real life, pathology may be less exciting, but no less important.
As a pathologist, I'm often asked what pathologists do. Sometimes they ask if I am a physician (I am, M.D. in hand.) The more knowledgeable non-medical person may ask if I do the same work as those television medical examiners or investigators. And the less familiar may warmly joke that "you're the kind of doctor I don't want to see!"
We do indeed examine the deceased, as autopsies are part of the profession. A busy pathologist in a medium-sized hospital may do about 30-50 autopsies a year. These are done largely to confirm the cause of death as a quality check on the clinical diagnosis and sometimes to determine why a patient died when clinical investigations drew a blank.
But the pathologist today has much more to do with the living than with the dead, even though we may not always get to meet the patient.
We perform such tasks as complex "frozen sections" - quick interpretations of a biopsy (a sample of tissue) from the operating room that's done to guide the surgeon in deciding what to do next in surgery. For example, the surgeon may notice a strange nodule on an appendix and ask the pathologist to determine if it's malignant.
We diagnose biopsies from various parts of the body, such as the skin, stomach, colon, lung, breast, or prostate. This diagnosis will help to determine what kind of treatment the patient will receive for his or her particular condition.
We also interpret pap smears, blood smears, microbes (disease-causing bacteria or germs), chemistry tests and oversee blood transfusions. We're assisted in all these procedures by certified laboratory technologists, who work closely with us and are responsible for the technical aspects of tests.
Because we're trained to interpret all the tissues of the body, we're able to interact with every specialty in the hospital, from radiology to obstetrics to surgery. Thus, we participate in screening services. A pathologist, for example, will diagnose every breast and prostate biopsy and abnormal pap smear. And we monitor ongoing conditions, such as blood cholesterol or abnormal growths like colonic polyps.
As it is with all of medicine, technology is also changing pathology. Today's diagnoses require ancillary, high-tech tests such as flow cytometry (classifying and counting individual blood cells) and immunostains (stains used to classify tumors), which are necessary as the biopsies get smaller and the treatments get more sophisticated.
In defining who we are and what we do, The American Society for Clinical Pathology says "Pathologists are problem-solvers, fascinated by the process of disease and eager to unlock medical mysteries, like AIDS and diabetes, using the tools of laboratory medicine and its sophisticated instruments and methods. Pathologists make it possible to apply scientific advances to improve the accuracy and efficiency of medical diagnosis and treatment."
That description may not be as entertaining as 'dropping from the sky' to prevent disease, but it's critically important work, especially for our patients. Even though you may never get to meet one of us, remember that we're an essential part of your health care. And the next time your physician tells you that "everything is fine with your test results," perhaps you should ask, "Doctor, what exactly did the pathologist say?"
Brinda Rodrigues Kamat, M.D., M.P.H., a board-certified pathologist at Mount Auburn Hospital in Cambridge, is President of the Massachusetts Society of Pathologists. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.
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