Pathologist on a trapeze
Pathologists are mistakenly regarded as acrobats of the microscope, able to divine the mysteries of a slide without reference to any other clinical information. This concept is alive and well in the minds of many an otherwise sophisticated clinician. Imagine presenting an air controller at JFK with a radar image of a plane, yet depriving him of any knowledge of its type, speed, course, origin, and even call sign. Imagine then instructing the controller to direct the plane towards an airport. Surgical pathologists are, by analogy, the air controllers that bring their pilots (surgeons and clinicians) to a safe landing. Many clinicians, perhaps because they are very busy and do not think too much about these things, keep their air controllers in the dark when submitting tissues to the laboratory. The clinical history that we receive is almost always flimsy or non-existent. This generalization does not apply to your physician or to a particular physician reading this paragraph. All that I am saying is that if one’s doctor is aware of important prior diagnoses, or that relevant radiologic information is available, or that one or two key ancillary test reports could influence the biopsy result, this should be legibly stated on the requisition. Failure to provide proper clues may cause the pathologist to make an interpretation that fails to address the question in the mind of the clinician. The result may either be an error, or a statement that is completely beside the point. The lack of a key piece of the history may also cause the pathologist to conduct a set of inappropriate tests, thus literally wasting precious tissue, perhaps necessitating a repeat of the biopsy procedure in order to start all over again. The use of extensive diagnostic coding has yielded a novel approach towards providing “information”, in that clinicians, instead of writing in plain English, tell us that a person who started out with a diagnosis of 616.0 was later found to have 795.00, and then 617.10.
Conversations with clinicians are often essential to an accurate microscopic diagnosis, because pathologists cannot operate in a vacuum. Getting hold of clinicians, however, is another matter. If the public thinks that it is hard to get a doctor on the phone, it is no less difficult for one physician to reach another. Someone ought to apply for a federal grant to study the amount of time that pathologists spend wading through interminable menus to reach clinicians, only to find that either the office is closed for lunch, the doctor is in surgery, in traffic, or out of town and that the covering doctor is inexplicably unavailable. Conversely, pathologists may be hard to reach at a moment’s notice because they, too, can only do one thing properly at a time.