Why Anatomic Pathology?
The reasons why some MDs choose anatomic pathology as a career vary greatly. In my case, I imagined that I had discovered a niche in which I would combine my interest in disease with an artistic inclination towards the poetry of images so sensitively described by Spencer Nadler in “The Language of Cells.” Here, I would find a voice through which my interest in the science of good patient care would nicely balance my right brain’s need to remain in touch with my creative, intuitive and holistic self. It did not take me long to find that I had made the right decision. Within months, after overcoming the initial technical barriers one encounters when starting in a field anew, I found myself completely at home at the microscope, developing a firm adherence to my chosen branch of Medicine, to the extent that I could later not imagine doing anything else. I plunged into texts and concepts that would become increasingly familiar and, as my confidence grew, I found myself moving into a most satisfying career, fulfilling my desire and obligation to look after patients, and to do it in a very significant and focused way. While this ideal seemed to hold during the first ten years after graduation, I came to realize during the mid to late 1980s that academic pathology (certainly in the United States) was gradually being driven in a direction that made it more difficult to feel fulfilled and to even exercise the most thoughtful, deliberative and investigative patient care.
In choosing pathology, many students are influenced during medical school by exposure to remarkable teachers who demonstrate a high level of intellectual satisfaction from this line of work. Some discover, quite unexpectedly, that purely clinical medicine goes against their grain. They may prefer a close encounter with the disease itself rather than indirectly through what they perceive as interminable ward rounds, dressings and undressings, history-taking, voluminous charts, and the not-to-be-underestimated combat with managed care companies. Even pathologists, however, find themselves subject to rules imposed by third party intermediaries. The factors governing the choice of this career are probably much more wide-ranging than I could imagine. All medical disciplines demand focus and concentration, attributes leading to good patient care and professional accomplishment. In pathology, entry-level obsession with detail goes a long way, but it is likely that the field itself will impose this quality upon anyone who persists in it for a length of time.