Allow me to discuss the pathologist’s role in health care. The public often has no idea what a pathologist is or what one does. I often have to explain what I do in so many words.

Pathology is the study of diseases. Medical students take a year-round course in pathology. If one flunks the subject, he/she is dropped automatically from the rolls. Such is the high regard for the subject since it is the bedrock of the practice of medicine. One has to know what the disease is before it can be treated properly.

But pathology is also a specialty, like internal medicine, surgery, OB-GYN or pediatrics. Upon passing medical licensure examinations, one has to undergo four years of residency training, and pass certifying board examinations given by the Philippine Society of Pathologists Inc., to practice either anatomic pathology or clinical pathology or both.

As medical professionals, we also charge professional fees for our services, which are much like radiologists who interpret images (x-rays, CT scans, ultrasounds, MRIs). It is a specialty that charges the least, and because we are hidden from public view, pathologists often suffer from discrimination from other medical specialists, who treat us like second-class citizens.

This is manifested in many ways. One is the condescending attitude towards clinical pathologists when a laboratory result does not support a clinician’s diagnosis. Often, clinicians say the lab made an error. A laboratory test is ordered to confirm a clinical diagnosis. If the two differ, there should be a question as to which one is correct. The clinician often asks for a repeat lab exam. While laboratory testing is not perfect (neither is a clinician), we have systems in place to ensure accuracy and prevent future errors. When the repeat test confirms the previous result, it is time for the clinician to reconsider his/her diagnosis.

Another issue is the treatment of anatomic pathologists in frozen sections, which are procedures in which the surgeon sends a piece of tissue or an organ for quick diagnosis by the pathologist which will dictate what further procedures will be done or not. While it is customary for the frozen section to be done during regular work hours, some surgeons schedule their cases in the early morning/late night or weekend without regard for the pathologist who may have been working the whole day. In extreme cases, frozen sections have been scheduled for the early morning hours, which was after the surgeon had gone partying and dancing the night away.

When the pathologist charges extra for the irregular hours or weekends, it is nowhere near the surgeon’s rate or even the anesthesiologist who usually charges a third of the surgeon’s fees. So, please don’t be mad when you receive the pathologist’s bill charging for his/her services during off hours/weekends. We too, have a life.

The clinical pathologist is also a victim of maltreatment by hospital/laboratory owners/administrators who often don’t give them the proper remuneration, claiming they don’t contribute much to the laboratory operations. Yet, it is the pathologist’s signature that licenses the laboratory and it is on the result form as well, which he/she guarantees, within reasonable limits, to be accurate. When a case is filed in court, the pathologist is also included in the charges by virtue of having his/her name and signature on the lab results.

Why is this so? Because it is the responsibility of the clinical pathologist that all the systems and procedures in the laboratory are geared towards producing accurate laboratory results through a quality assurance system that ensures all the steps leading to the production of results from the accurate identification and acceptance of the sample (pre-analytic), analysis and production of the result (post-analytic)are accurate. The analytic phase factors include a properly validated test kit and equipment, and proper controls (with qualitative tests, negative and positive controls; with quantitative tests, different levels of the analyze and negative controls), all of which must be ran before their expiry periods.

Thus, all clinical decisions are based not just on the clinician’s clinical acumen, it takes into consideration the pathologist who ensured the accuracy of your laboratory results and who read your tissue biopsies and staged your cancers.

With the advent of targeted therapy for cancer, the pathologist now plays a crucial role in testing for molecular targets for prescribing the exact drug using immunohistochemistry (IHC) and in-situ hybridization (ISH). Thanks in part to the pathologist, no longer is cancer treated only with toxic chemotherapeutic agents. The new drugs, usually monoclonal antibodies, are well tolerated and non-toxic, killing only cancer cells.

When you next are admitted to a hospital or are simply consulting a clinician, please remember, your care will not be complete and safe without the presence of an unseen partner in your care, the pathologist.