Anatomy of a Kitchen
The route leading into the specialty of pathology begins with the M.D. degree, which one hopes is preceded by a period of life during which the doctor-to-be is naturally conditioned for a career in which the mental and physical health of others plays an important role in his or her thinking. Adopting the ethical and compassionate traditions of the profession, trainees in pathology study diseases in an approach very different from that of the internist or general practitioner, who is mostly concerned with the clinical application of what is known by pathologists. Many people have vastly skewed ideas of what pathologists do, flowing from stereotypes generated in the media, such as via the once popular TV show, Quincy. From isolated examples, many know only one type of pathologist, the one that works with the dead. Pathologists, however, are no more pre-occupied with death than the internist or oncologist, who must regularly deal with afflictions that threaten life. The field of pathology has two major divisions: clinical pathology (CP) and anatomic pathology (AP), an unfortunate nomenclature because both branches respond to clinical needs and both involve living patients. My account describes the world of anatomic pathology and does not approach the other division, which focuses on microbiology, body chemistry, and blood disorders. Most pathologists in the USA were initially trained in clinical and anatomic pathology, but their work is often mainly anatomic.
In the most general way, anatomic pathology deals firstly with the naked-eye (gross) examination and handling of human tissues and organs, and the later, separate analysis of tissues and cells via the microscope. Three subdivisions co-exist under the umbrella of anatomic pathology: (1) surgical pathology (studies the tissues of living subjects), the essential subject of this account; (2) cytology (examines individual cells, as with the Pap smear); (3) autopsy pathology (pathology of the dead, in the service of the living). Pathologists like Quincy deal only with forensic autopsies, i.e. on those who die from unnatural causes. Quincy, to become a forensic pathologist, went to medical school, became an MD, then became a conventional pathologist, and only then studied forensics, in order to become a medical examiner.
Anatomic pathologists, trained as doctors who deeply understand the manifestations of disease, do much of their work by observing shapes, sizes, colors, textures and patterns, and then reporting on what they see, in terms meaningful to a patient. It is now possible for anatomic pathologists to visualize molecular abnormalities, to demonstrate immune phenomena under the microscope, and to increasingly blend the fascination of science and imagery in the interest of patient care. At the time of writing, a Google search under "Anatomic Pathology" yielded 67 pages.