COMMENTARY

From Hospital Halls to Popular Culture, Pathology in the Spotlight

Abdul M, Abid, MD

Disclosures

September 14, 2022

Recently, I ran into some non-pathology residents from my institution. We got to talking, and I told them that I was training in pathology. Then came the barrage of questions and stereotypical jokes. "When do you usually come to work? 9 AM? 9:30 AM? You're probably done by, what, 3 PM?" What pains me the most is that these comments were made by other physicians — not laypersons — who were falling for the pervasive stereotypes that exist around pathology.

A 2018 study published in Cambridge Medical Journal and conducted among Cambridge University medical students on stereotypes in medicine highlighted that there was not a single positive attribute associated with pathologists. Another study published in the Journal of Clinical Pathology showed that medical students often do not pursue pathology because they think pathologists "don't care for living patients" or "they prefer to see dead patients." This is not surprising; during my training, I have had numerous interactions with other physicians who did not seem to understand the work of pathologists.

Importantly, data also show that negative comments about pathology in online forums, such as the Student Doctor Network, are a major contributor to deterring US medical students from pursuing pathology Unfortunately, students eliminate pathology as a specialty choice before entering clerkships and miss the opportunity to explore a specialty they might otherwise enjoy. 

But stereotypes also dominate popular culture, and pathologists are scarcely shown in a positive light in television series or movies. In the movie Pathology, a group of pathology residents spend their time plotting murders — the last thing that residents have time for. In House, M.D., non-pathologists perform all lab testing and even perform autopsies. In The Sopranos, frozen sections and biopsies are performed almost magically, as if pathologists are nonexistent. In Dexter, a forensic technician leads a parallel life as a serial killer. It's no wonder that pathologists are associated with death in our society.

These negative stereotypes have larger implications for the practice of pathology. At last count, pathologists only make up about 4% of all doctors in the United States. Not only is it easy to ignore and cut funding for things that are invisible, but in recent years, lawmakers and insurance companies have tried reducing payments for pathology services by cutting Medicare payments and denying payments for professional components. This onslaught is not going away any time soon, and visibility as well as advocacy are going to be pivotal to keeping pathology afloat.

So, what do pathologists really do?

In a nutshell, pathologists look at biopsies, conduct autopsies, and manage clinical laboratories. However, that description barely scratches the surface. Cytopathologists are doctors who diagnose cancerous cells on the basis of fine-needle biopsies. Transplant pathologists determine whether a donor organ is working effectively in a patient's body. Transfusion medicine pathologists manage blood banks and oversee donor plasma procedures. Molecular pathologists run and interpret complex testing to interpret genetic mutations in cancer, thus paving the way for targeted therapy. Pathologists are and have always been at the forefront of medical advancement and the discovery of new therapies.

How then do we, as a pathology community, address these misconceptions? Although we may never completely stop stereotypes, there are ways we can change the climate and promote more positive perceptions and boost accrual.

Visibility is most important.

Pathologists need to be on boards and medical curriculum committees to advocate for pathology; otherwise, it will be wiped from the curriculum. They should take an active role in teaching and working with students to engage and foster an interest in and excitement about pathology — for example, by sharing life-changing diagnoses. They should try to engage medical students and general audiences through social media platforms, including Twitter, Instagram, and TikTok. Attracting more students toward pathology will ensure that the profession survives and gains its rightful place in the house of medicine.

But pathologists should also be actively engaging in grand rounds and discussions about patient care with clinicians to overcome misconceptions about our work and form important alliances that can be leveraged both internally and externally.

It's time for pathologists to shine a light on our work. We are integral to the practice of medicine.

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