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

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

Conclusions

Pathologists identified several ways by which including patient-pathologist interactions in the field of pathology could impact patients, pathologists, and the field of pathology. Most of those surveyed were interested in meeting with patients to discuss their report and show them their tissue under the microscope. Pathologists highlighted potential positive impacts to patients in the form of improved cognitive and emotional processing of their diagnosis and also noted the potential for improved pathologist job satisfaction through increased patient contract. Others noted that including patient-pathologist interaction in the scope of a pathologist's work could improve the image of the field of pathology and the quality of patient care. For each of these areas, there were also concerns about negative impact—notably, confusing patients, overwhelming pathologists logistically and emotionally, and muddying the waters of patient-clinician team interactions by adding the pathologist to the team. Future work should investigate clinicians' attitudes toward patient-pathologist interactions because clinicians are also key stakeholders whose ideas and attitudes must be investigated and described.

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Acknowledgments
We thank the pathologists who took the time to share their voices and opinions.

Table 1. Characteristics of Respondents (n = 197)
Characteristic	Value
Mean age, y (n = 195, 2 missing)	39.4
Gender, No. (%)
Female	99 (50.3)
Male	97 (49.2)
Other	1 (0.5)
Type of practice, No. (%)
Academic	130 (66)
Community	53 (26.9)
Other (eg, VA/military, commercial)	14 (7.1)
Physician rank, No. (%)
Resident or fellow	59 (29.9)
Attending, junior (1–5 y out of training)	55 (27.9)
Attending, midlevel (6–10 y out of training)	33 (16.8)
Attending, senior (≥11 y out of training)	50 (25.4)

VA, US Department of Veterans Affairs.

Table 2. Major Themes and Subthemes, With Representative Quotes From Free-Text Responses Regarding Pathologist's Attitudes Toward Meeting With Patients
Theme	Subtheme	Representative Quote
Impact on patients	Cognitive	"Patients are increasingly savvy and want to understand their disease. The treatments are critically related to the right diagnosis. Patients want to feel comfortable their diagnosis is correct. In pathology we are the key people to be able to do that."
		"… they will be more informed about their disease and they will get the scientific information about their disease from the main doctor who has diagnosed it and this, at times, really helps as for some diseases the treating physician does not have enough data."
		"I think pathologists can offer patient's a different perspective—show them their tumor/cancer so they can see with their own two eyes. Our specialty has also always been very education-oriented and I can't think of any better opportunity to educate our patients."
		"As pathologists we deliver diagnosis that can shake the foundation of a patient. Some patients want to know everything they can to cope and some want to know very little because it helps them through the tough road ahead. If I could help a patient interact with and understand their diagnosis that I have made, and help them, count me in!"
		"I think patients may become very confused because we use terminology the clinicians sometimes don't understand."
		"I'm not sure how much patients will understand from the details of the report and the microscopic features that are sometimes hard to explain to their primary clinicians."
	Emotional	"I've done it. It gives them the certainty that their biopsy it's been treated by a person with expertise and that gives them peace of mind."
		"I think it's educational, and in some cases empowering for them to see what their disease looks like. Puts a 'face' to the name."
		"Because it's always better see with your own eyes what happened to your tissue."
		"Because I want to make her relaxed, maybe she can't ask questions to clinicians so I want to talk to her."
		"Based on my experience as a physician and then pathologist/dermatopathologist, patient react much better and more responsive when they know exactly what happens when you show them their biopsy and explain it to them."
Impact on pathologists	Patient contact	"I miss patient contact."
		"Would love to take an active role in the patient's care."
		"I enjoy connecting with patients and miss doing so regularly."
		"I primarily chose pathology because I do not want to deal with patients."
	Job satisfaction	"It would give pathologists a fulfilling reason to get up in the morning and would probably regenerate our motivation to complete the less interactive parts of our work."
		"Sometimes I feel as a pathologist I am too far removed from patient care. While what we do is tremendously important and we are an integral part of a patient care team, I think more patient exposure would make our profession more relevant and perhaps provide more job fulfillment."
		"Would help bring me back to my purpose."
		"Talking directly to your patient gives a best ever job satisfaction of being a physician."
		"I chose to be a pathologist because I don't really like to have a direct contact with the patient, and it is not because I don't care, but because sometimes I care too much. I am sure I would suffer if I had to explain I-don't-know-what to them."
		"I don't have extra time or desire."
Impact on the field of pathology	Image of pathology	"I think it would also make patients aware of pathologists as physicians, helping to improve our public image, assistance that is sorely needed."
		"It is of vital importance that pathology as a field becomes more patient facing. When patients don't even know that pathologists exist or are physicians or don't 'just do autopsies' or that we are the ones that actually make the diagnosis that directs the care patients receive, we get left behind in every legislative action or regulatory change or paradigm shift. Those who don't act will be acted upon. We are currently being acted upon. We need to change that. Becoming patient facing is a key to that change."
		"It would humanize and put a face to someone whose name they see on a bill."
		"Face-to-face interactions with patients are severely lacking in pathology. Seeing the patient humanizes our specialty."
		"I am a medical student going into pathology, and I think this kind of program could address the 'pathologists don't see patients' concern that medical students have about entering the field while also being of great benefit to the patient."
	Quality of care	"Provides better care by better communicating results."
		"To establish a real and fruitful relationship between the pathologist and patient what gives rise in turn to better results."
		"I think patients really don't get an opportunity to fully discuss their pathology report in a way that they deserve. And by bringing pathology into the in person patient care team, this expands and brings a comprehensiveness to patient care like never before."
		"I'm not sure if there is a possibility of mixed messages from clinician and pathologist."
		"Pathologists work best by spending time communicating with clinical team rather than patients. Further, pathologists don't have the clinical training and may even undermine the clinical team by giving out the wrong information."

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

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