Why do my slides need to be reviewed?
Unlike in the past, when a patient would undergo all diagnostic assessments and treatment under one roof, many people now have biopsies performed in one location but their operations at another. This raises legal issues with regard to actions taken at one institution that rely on a diagnosis made elsewhere. Thus, if patient X has an operation that is based on a diagnosis made by a pathologist not employed by the hospital where the operation will occur, then the treating hospital must ensure that patient X receives the best care that the treating hospital can offer. This includes a report that its own pathologists agree with the pathologic diagnosis made at a different facility. Therefore, the hospital (through its by-laws) mandates that externally diagnosed slides be internally reviewed for accuracy before the surgeon proceeds. Without this policy, the patient, surgeon, and hospital would be at risk should the operation be performed without review of the “outside” slides. In most cases, the original diagnosis is sustained, but when interpretations differ, the initial treatment plan may change.
What causes the most trouble in this area is the difficulty experienced by the hospital pathologist in obtaining the relevant slides from the place where the biopsy was first read. Fragmentation of services, with biopsies being handled in different venues, has greatly complicated the gathering of a patient’s pathology material. The reasons why an operation dependent on externally reviewed slides may be delayed could include any of the following: (1) the surgeon’s office has not made a timely request for the slides; (2) the original facility cannot easily find the slides or is tardy in sending them out; (3) the slides arrive, but are either the wrong ones, or a key slide is missing; (4) the correct slides arrive just before the operation is due to commence, but the hospital pathologist cannot examine them with only minutes to spare; (4) the correct slides arrive, but because there is a disagreement about the diagnosis, a secondary consultation must be obtained from yet another consultant. Pathologists do not like to be in a position of having to call for the postponement of a scheduled operation, yet do need sufficient Time for a thoughtful review. A surgeon who brings in slides and asks the pathologist to give him an opinion because the patient will be on the table in 45 minutes should not be surprised when the pathologist declines.