Sunday, May 06, 2007

Go be a pathologist then!

Yesterday I was surfing around the latest Britmeds and discovered an interesting but typical example of ‘pathological ignorance’ (there’s also a link to a good article just below here!). When I say ‘pathological ignorance’ I mean the failure to understand what pathologists actually do, which tends to lead to statements like this one (on the subject of doctors refusing to do abortions):

If those doctors don’t want to do so, they should consider going to work in pathology, where most of the human beings they come across will already be past giving a damn about a doctor’s precious prejudices or their religious hang-ups.

Contrary to what Ben Fenton, the author of this article thinks, we do have religious issues with abortions in pathology. Some pathologists do not report specimens of ‘products of conception’ derived from abortions; the issue does not go away outside the gynaecology department.

The author of this piece also makes the mistake of assuming that in pathology the vast majority of our patients are dead. Not true. In most departments I’ve worked in there are around 10 times the number of living patients (their specimens, at any rate) than dead ones examined by us pathologists. He also assumes that the dead will not care about our prejudices or religious hang-ups; maybe the dead don’t but their relatives certainly might. In pathology it is more often the religion of the family that impacts on us as certain faiths need to bury the body as soon as possible after death so an autopsy needs to be done more quickly.

A second issue with autopsies is that in some cases the relatives, via the coroner, will allow only a limited autopsy which may not answer the questions posed by the death. As pathologists we want to do a high quality autopsy that is thorough, answers the questions and doesn’t miss anything. In cases where the pathologist thinks the autopsy will be too limited to be of use, he or she can refuse to do the autopsy (RCPath Guiodelines on Autopsy Practice 2002 section 4.6.2). Does this count as ‘prejudice’ or professionalism in Ben Fenton's book?

22 Comments:

At 16:49, Blogger The Angry Medic said...

Whoa. I haven't been here in a while, Dr K, but as usual you offer up a spectrum of great writing. The title of this post had me sniggering insanely (I have no idea, it just sounded...funny. I could SO see it as the punchline of a joke).

Then I stumbled upon your Anonymity post and read the excellent comments too. I've just been stalked, albeit by two bloggers who knew me, but it just shows how precious anonymity is, doesn't it? And no matter what anyone says, it DOES affect your writing, for the reasons you enumerated so well.

Keep writing the good stuff Dr K! I'll be back.

 
At 17:38, Blogger HospitalPhoenix said...

I agree, Dr K always has good stuff here.

One of the aspects of pathology which has brought me to consider it as an alternative career is its role in undergraduate teaching. When I did my Training the Trainers course there was a pathologist on the course who did loads of teaching at her University, and she loved it.

(However, I'll never forget sitting next to the pathology tutor in our first lab, and having something large, pink and slimy waved at me. "Is this a left or right lung?" she asked. Luckily I saw the fissures as the dripping lung was waved through my field of vision, and guessed correctly)

 
At 20:47, Blogger Cal said...

Ew! Lungs flapping through the air...

Well, we cover path in our fifth year, apparently, and apparently it's BARE DIFFICULT.

Eeek.

 
At 20:47, Blogger Cal said...

Please interpret the above comment as: I'll be running to you for help in my fifth year.

Thanks.

:)

 
At 17:01, Blogger HospitalPhoenix said...

For Cal - I wasn't crazy about Path as a student, as it was something which involved dead bodies and underground labs.

However, when I revisited Path as a surgical trainee studying for MRCS, I looked at it as a specialty which complements all the others, and from which we can learn a huge amount. I was very lucky that I worked alongside some great pathologists who would bleep me when they were looking at specimens or PMs from patients of mine, and let me run down to the labs and have a look at the specimens and slides. It sort of completes the surgical journey (in a morbid sort of way)

Oh shit, now I sound like an educationalist. Someone shoot me now (then take me to Dr K for a teaching PM... I hereby donate my body to medical education and consent to the removal of body parts for research...)

 
At 08:57, Blogger Dr K said...

Thanks guys.

I probably don't appreciate how good anonymity really is as I haven't so far 'lost' it. I certainly don't envy you being stalked, Angry. Hope it doesn't affect your writing too much.

Pathology is cool, although I think you'd be better as a surgeon than as a pathological specimen, Phoenix! We do appreciate clinicians coming to see specimens/slides/patients they've sent us (in fact them not coming to do so is another one of our 'pathology gripes'!)

I can't believe you don't do path until 5th year, Cal. That sounds a bit mad. I won't say it isn't difficult because it can be, but if you're looking at slides and specimens the most important thing is to get taught by somebody who can show you the important bits. It's really difficult to learn that sort of thing by yourself, even if you've got a book etc. Books are good for theory, but specimens don't always look like the pictures in them!

 
At 11:57, Blogger DundeeMedStudent said...

hello
It's odd we do bits and bobs of pathology, throughout our course here, but nobody wants to be a pathologist.
When I let slip I was considering it as a career. I got a torrent of abuse about not being a proper doctor and surely if I wanted to dye slides pink for the rest of my days surely I should have just become a biomedical scientist in the hosp after my degree!! I was slightly outraged.
There needs to be more public education as to what the pathologists do and definetly much more education within the medical curriculum- but I doubt that'll happen any time soon.

 
At 12:48, Anonymous Anonymous said...

I don't mind that certain pathologists will refuse to examine specimens from procedures they find distasteful, but should patient/relative religion be taken into account when deciding how quickly to do an autopsy? if you wouldn't accede to a well-reasoned request from an atheist family to expedite an autopsy, why should you accede to an irrational one from a religious family?

 
At 15:04, Anonymous Mike Davies said...

Politeness?

Why not?

 
At 14:53, Blogger beajerry said...

Do pathologists listen to techno/electronica music when they do autopsies?

I would.

 
At 12:04, Blogger The Angry Medic said...

Hahaha - you can tell Beajerry's been watching a wee bit too much Scrubs :)

And I like Path. I think I'm gonna do that next year actually. Was wondering when you'd pop over to my place and try and convert me :)

 
At 08:31, Blogger Dr K said...

Hi guys

When anybody gives you abuse for wanting to pathologist, Dundee, tell them to F OFF! Seriously, anybody who thinks pathologists spend their time staining slides needs to get down to the pathology department and find out what we really do (staining slides is very rarely involved). These people are ignorant and should be told so!

We do try to do autopsies more quickly if there is a reason, either religious or not, although sometimes it isn't possible.

Definitely no techno, beajerry! Most mortuaries I've worked in are music-free, at least in the autopsy room.

Hi Angry, I don't really go in for converting people, just encouraging the ones who are already interested. I say go for it!

 
At 11:01, Blogger Dragonfly said...

Right on.

 
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