UNDER THE MICROSCOPE
Last week, we had the 73rd Annual Convention of the Philippine Society of Pathologists Inc. (PSPI). It was an occasion to meet with colleagues especially after the pandemic. More than that, the convention was an opportunity to update on the newest advances in pathology. Medical science has advanced by leaps and bounds in the last 20 years and the field of pathology is no exception. There is new equipment and instrumentation as well as cutting-edge information especially in molecular science.
Even in routine laboratory testing, improvements have come about to give us more accurate and precise results. As the person in charge of running the laboratory, the pathologist is responsible for maintaining quality results through his/her supervision and guidance. Thus, when you get a laboratory result, kindly take a look at the bottom right corner where the pathologist’s name and signature are. That is your assurance that your result has been generated in a laboratory that subscribes to the best laboratory practices.
Your attending doctor will be at a loss if he/she doesn’t have laboratory results to establish, confirm and validate your clinical diagnosis. He/she needs the labs to know which drug to prescribe for your illness. That’s just for “medical” illnesses as opposed to surgical cases, where the surgeon is called upon to perform invasive procedures to remove tumors or diseased appendices, gall bladders, breasts, and other organs or tissues for patients to heal.
In these cases, when you’re diagnosed through a blood test or imaging, the surgeon can confidently remove tissues/organs that were judged to be the culprits.
These excised tissues/organs are also examined by the pathologist through gross and microscopic examinations to document the presence of disease or cancers. Again, without this pathological examination, there can’t be confirmation of the disease plaguing the patient.
Nowadays, with the advent of immunohistochemical and/or molecular testing, the pathologist can determine if the cancer examined has an “actionable” genetic component, meaning that a gene involved in the formation of the cancer can be targeted with new drugs being developed to fight these cancers. Thus, the pathologist is an indispensable partner of the medical team treating a cancer patient. Such a multidisciplinary approach is now mandatory in navigating the complex issues in treating patients with cancers.
Pathologists are normally invisible to the patient yet they have a crucial role in medical treatment. Such a situation often results in complaints about why are they paying the professional fees of a doctor whom they haven’t even seen or met. This is often the case with frozen sections, when the pathologist is called upon, whatever the time of day or night, to examine tissue newly excised from the patient during surgery and determine if it is cancer or not. This is essential for the surgeon to proceed with a radical operation such as a mastectomy. Pathologists need to guide the surgeons’ actions in the operating room in these cases.
What does it take to be become a pathologist? After medical school graduation, the budding pathologist has to undergo a four-year training residency program in a PSPI-accredited hospital during which he/she has to learn and master many skills and far more knowledge than an internist, surgeon, OB-GYN or pediatrician.
This is because pathology cuts across all medical specialties and pathologists need to know all about the workings of the human body to make the diagnosis upon which the clinicians rely to diagnose and treat patients.
Then, he/she must pass certifying board examinations in anatomic and clinical pathology before he/she can practice pathology. A subspecialty fellowship takes a minimum of one year after passing the boards.
Even after that, a pathologist must continually keep up with new and sometimes dizzying developments in medical technology and knowledge. Cancer classifications are also constantly changing due to new discoveries and research. Pathologists need to be up-to-date with these.
Thus, the pathologist seldom, if ever, hogs the spotlight in medical care and is usually the lowest-paid physician in the hospital, yet he/she is essential. These PSP Hymn excerpts (set to Beethoven’s Ode to Joy) sum it up thus:
We’re specialist pathologists
Lamplight of all specialties
We give the clearcut truthful seal
Guiding doctors’ hands to heal
It’s our word that makes it final
Casting dark of doubts away
Microscopes and analyzers
Make us see beyond the veil
Some may ask why this could be true
We say that is what we’re trained to do
Searching answers to the mysteries
In man’s blood and flesh
We aid doctors’ diagnoses
Help the sick and ease their pain
In labs patients seldom see
We work with confidentiality
The next time you meet a pathologist, whether it be socially or professionally, kindly take a moment to recognize his/her role in your health care.
Pathologists, take a bow!