Pathology's Challenges

From the American Society for Clinical Pathology



This is my last President's message and I want to comment about some of the challenges facing our profession and what I believe we must do to meet them. Be sure to also read "Creating a New Breed of Pathologist" in this month's issue of Pathology Today ( The article is based on a presentation given in March by Bruce A. Friedman, MD, a pathologist and informatics expert at the University of Michigan.

The challenges are many: new and rapidly changing technology including molecular diagnostics; outsourcing of laboratory testing; capability of instantaneously transferring digital images around the world; and medical decisions based on economics, often with little input from pathologists. I could go on...but the result of our changing environment has been that pathologists are becoming more distant from clinicians and from the patient and, therefore, are becoming marginalized in healthcare systems. What can we do to counteract this trend and assure that pathology as a profession will flourish in the future?

Dr. Friedman believes, and I agree wholeheartedly, that anatomic and clinical pathologists must eliminate barriers that separate them from each other and from clinicians. How do we do this? As it turns out, new technology, including molecular diagnostics, is already blurring the border between clinical and anatomic pathologists because molecular tools can be applied equally to what we regard traditionally as clinical or anatomic pathology.

By embracing new technology, pathologists can become active partners with clinicians in both diagnosis and treatment decisions and, therefore, be integral to patient care over a wide spectrum of diseases -- those that require a tissue biopsy and the vast majority of diseases for which the diagnosis is made by laboratory testing.

Molecular and genetic testing is affecting every area of pathology and has already made a tremendous impact in my own subspecialty of hematopathology. Patient care definitely is enhanced. Although these advances could be viewed as threats because the "gold standard" of morphology is challenged, pathology is in a unique position to enhance its traditional role of bridging basic science with clinical medicine.

The rapid changes are making laboratory testing highly complicated. Pathology can help -- not only by developing and performing testing, but also by participating with clinicians in determining when tests should be done, interpreting and correlating results with other clinical and laboratory data, and making treatment decisions. Here's a warning: Pathology and pathologists need to be leaders in this area because if we aren't, another specialty certainly will step in to fill the void.

To do this, pathology also needs not only to understand the biology of diseases but also to be as clinically oriented as it has ever been. I recognize that this may be difficult, and it certainly is time-consuming, but, I must admit, clinical interaction is one of the most rewarding parts of my career as a pathologist.

I was fortunate to have had a mentor who actually "did it." He went to the patient wards to view charts (no electronic medical records back then), talked to patients, occasionally examined them (eg, check spleen size), and collaborated closely with clinicians in both diagnostic and treatment decisions. I am not suggesting that we do all this but we can all undertake some things (and be role models in the process).

  • We can "reach out" to a clinician when we run across something we think she or he needs to know while treating his or her patient. I have found them to virtually always be receptive and appreciative.

  • We can put together presentations that will update colleagues on new technology in the laboratory that has an impact on diagnosis or therapy.

  • We can be active participants in patient care conferences.

  • We can use informatics to bring us closer to patient care rather than distance ourselves from it.

  • We can work alongside of -- instead of at loggerheads with -- administrators at our institutions. I know from experience that it is not easy in all settings, but if this alliance can be made, a powerful collaborative team is formed. I think it's important to remember that administrative decisions are, more often than not, also medical decisions. We need to be there when the decisions are made.

And lest you think I've forgotten the laboratory professionals in these remarks, let me say that the admonition to embrace and lead the application of new technology and collaborate with caregivers in patient care is as relevant for laboratorians as it is for physicians. And it can lead to exciting new career options.

For instance, I'm aware that some laboratorians are serving as hospital infection control practitioners -- and why not? Their experience in the laboratory makes them great problem solvers and all of the patient results come from testing in the laboratory. Some laboratory professionals are making rounds in intensive care units and are welcomed by clinical caregivers.

If we do these things, the future for pathology and laboratory medicine will look bright, indeed!

Thank you for allowing me the privilege of serving as your President. I look forward to staying in touch and continuing -- as an active ASCP volunteer -- to advocate on behalf of our profession.

LoAnn Peterson, MD, FASCP
American Society for Clinical Pathology


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