A Qualitative Study of Pathologists' Attitudes Toward Patient-Pathologist Interactions

Cathryn J. Lapedis, MD, MPH; Lauren Kroll-Wheeler, MD; Melissa DeJonckheere, PhD; Dustin Johnston; Scott R. Owens, MD

Disclosures

Am J Clin Pathol. 2021;156(6):969-979. 

In This Article

Abstract and Introduction

Abstract

Objectives: This study qualitatively explored and described pathologists' attitudes toward patient interaction.

Methods: In a survey to pathologists, we asked, "How interested would you be in meeting with patients to discuss their pathology report and show them microscopic images of their tissue?" Then, we asked "Why," followed by a free-text box. We asked pathologists to assume that their time would be adequately compensated and that patients' treating clinicians had already told them their diagnosis. Physician age, gender, rank, and type of practice were also collected.

Results: We surveyed 197 pathologists, 86% of whom were either definitely interested or interested in meeting with patients. Interest level did not differ by age, gender, or rank but was higher in academic practices than in community practices. Thematic analysis showed that pathologists believed that meeting with patients could impact (1) patients, through cognitive and emotional pathways; (2) pathologists, through patient contact and job satisfaction; and (3) the field of pathology, through quality of care and a redefined image of the specialty.

Conclusions: Pathologists' interest level in meeting with patients was high. Potential impacts on patients, pathologists, and the field of pathology were identified.

Introduction

For much of the history of medicine, the same person interacted with, diagnosed, and treated a patient. Anatomic pathology, including autopsy and general surgical pathology, is a relatively modern specialty that arose in the early to mid-19th century.[1] During pathology's early days, autopsies were typically performed by the treating clinician, who would investigate the gross findings of patients after their death.[1] Advances in surgical technique, anesthesia, and frozen section technique later led to the development of the hybrid surgeon-surgical pathologist, who would perform frozen sections for diagnosis on patients during surgery.[1,2] It was not until the mid-20th century that surgical pathologists began working independently in their own departments, separated from other clinical disciplines, such as general surgery or gynecology.[1]

Recently, pathologists have called attention to this relatively modern disconnect between patients and the physicians who make their tissue diagnoses, urging better communication between pathologists and patients.[3–5] Thought leaders have suggested that pathologists reach outside their comfort zone behind the "paraffin curtain" to interact more with clinicians, surgeons, and patients.[4,6] Anecdotal stories and small pilot studies on successful patient-pathologist interactions and patient-pathologist consultation programs have recently been published.[3,7–11] Additionally, early work regarding patient attitudes shows that a majority of patients with cancer are interested in meeting with their pathologist to see their slides and more fully understand their pathology reports.[12] The term pathology explanation clinics has been coined by Gibson et al,[4] who describe a shared meeting between pathologists and patients for which pathologists are trained in communication skills and in which they share their unique knowledge of tissue diagnosis with patients. Pathologists are key stakeholders in the development of pathology explanation clinics, and it is therefore important to characterize pathologists' attitudes about patient interaction before attempting larger-scale interventions or broadening the scope of pathology to once again include patient-pathologist interactions.

In this report, we use descriptive and thematic analysis to describe pathologists' level of interest in and attitudes toward meeting with patients. We use qualitative methods to describe key themes in both interested and uninterested pathologists. A qualitative research approach is valuable when exploring unknown phenomena, describing processes and theories, and generating hypotheses. By using the perspectives and experiences of pathologists in their own words, we are able to identify factors (eg, attitudes toward patient-pathologist interactions) that would influence future development of patient-pathologist explanation clinics or consultation programs.

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