The changing role of the pathologist
CMAJ 1997;157:1346
The title for this letter was also used in a poster presented by Drs. N.S. Gill and Sandip SenGupta at the recent 60th annual meeting of the Ontario Association of Pathologists. They told of a 16-year-old with an above-the-knee limb amputation for Ewing's sarcoma. "Postoperatively, this patient made the unusual request to review the surgical specimen with the pathologist. We were presented with a unique opportunity to discuss the disease with her and educate her about the role of the pathologist in the diagnosis and treatment process."
A recent issue of Harper's magazine included an article by Dr. Spencer Nadler, a surgical pathologist from southern California.1 In the article he described conversations with a patient who had asked him to review with her the histology of her malignant breast lesion, discovered at biopsy.
A recent study concerning abnormal cervical smears2 concluded that "most women did not receive the information they required. We also found that women's accounts of their abnormality often conflicted with their clinician's approach."
In cases in which patient care and management are driven by interpretive pathological reports, be they related to biopsy, cytology, cytogenetics or hematology, it is inappropriate for the pathologist to be left out of the patient-contact loop. The most appropriate person to explain, and even show, the pathologic features is the pathologist, whose training involves not only the pattern recognition of tissue diagnosis but also the natural history of the disorder and its basic biology.
Many patients must find it difficult to accept a diagnosis when only a slip of paper is given as proof of their illness. In my experience with prenatal diagnosis I often face questions. "Was a mistake made? Could there be a mix-up in the specimens?" When I see families, I have the karyotype with me and can demonstrate the changes and explain the laboratory's quality control. How much more difficult must it be for a man faced with therapeutic decisions about prostate cancer or a woman with malignant melanoma not to be offered the opportunity to see and discuss the biopsy results with the person who interpreted them.
I believe that every pathology report should include a statement that the pathologist would be pleased to discuss the diagnosis with the patient. Such contact will allow patients to satisfy themselves about the validity of the diagnosis and would also give the pathologist a deservedly higher profile in patient management.
H. Allen Gardner, MD
Director of Genetic Services
Oshawa General Hospital
Oshawa, Ont.
References
- Nadler S. A woman with breast cancer: the will to live, as seen under a microscope. Harper's Magazine 1997;294(June):70-5.
- Kavanagh AM, Broom DH. Women's understanding of abnormal cervical smear test results: a qualitative interview study. BMJ 1997;314:1388-91.
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