What does a pathologist do?

Oncologists and pathologists are physicians who are linked by cancer. Oncologists treat the disease. Pathologists diagnose it. The two specialties are connected, yet significantly different.

Pathologists are, in essence, the detectives of the medical field. They spend their days in the lab. They examine body fluids, cells, and tissues to help identify diseases. Although pathologists are instrumental in determining what may be physically wrong with someone, they have little, if any, direct contact with a patient. Oncologists, conversely, spend a great deal of time with patients. Both, however, may be involved in a patient’s care. Pathologists also perform autopsies to figure out why someone died.

Oncologists are cancer specialists who may be medical, surgical, or radiation oncologists, and who may further specialize within the discipline. Pathologists diagnose all medical conditions and diseases, not just cancer. They may specialize in the diagnosis of pediatric or genetic disorders, skin diseases, diseases of the nervous system and skeletal muscles, diseases that affect blood cells; or in transfusion medicine or forensic pathology.

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The process of becoming a pathologist takes between twelve and thirteen years, as follows:

Bachelor’s degree – four years Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree – four years Residency – four or five years (four years for anatomic pathology; five years for the recommended combined track of anatomic/clinical pathology)

Clinical pathologists are specialized physicians who diagnose diseases by examining and testing cells, bodily fluids, and tissues. They interpret the results of lab tests so that informed decisions can be made regarding patient care. This kind of work strongly suggests that pathologists are predominantly investigative people.

When asked why they chose pathology, practising pathologists often cite these reasons:

 the field’s unique blend of imaging, challenging diagnostic dilemmas, and access to and experimentation with cutting edge technologies

 the privilege of being the ‘doctor’s doctor,’ the preeminent consultant to other physicians

 the privilege of being at the forefront of patient diagnosis and involved in critical decisions that affect patients’ lives

 the degree to which pathology allows its practitioners to lead a balanced life, as the time demands are not nearly as pressing as those in surgery and other medical fields which involve more patient interaction

When asked about the attributes that accomplished pathologists possess, physicians in the field from around the world made the following comments [paraphrased compilation]:

I think that you have to be born with a certain visual aptitude. You have to be able to build pictures in your mind. That’s why the training takes a long time, since you must develop this innate visual ability and marry it to rigorous scientific learning. You have to come to appreciate the intrinsic beauty of microscopy itself. A colleague of mine told me that one question she always asks residency applicants is about their hobbies; if they like art or photography in particular she feels they are more likely to be a good pathologist than if they have other orientations.

First of all, I think you have to be good at pattern recognition. You’re constantly looking at patterns, colors, and their relationships to make a diagnosis. You have to be thorough in your thinking: ‘Well, if I haven’t seen this before, what must I do to try and make the diagnosis? Do I need to do more special testing? Do I need to consult somebody else? Do I need to do more reading about this?’

You have to be a good observer. You have to be an observer of minutiae – to look at the little things. Little things make a difference. And you have to know what those little things mean – so that’s where your academic training comes in. Probably the most serious fault in a potential pathologist is not being thorough enough.

You have to have imagination and conviction and should not be afraid to question. If you see something that doesn’t fit any disease you know or that has been written about in medical journals, don’t automatically assume that you don’t recognize it because of a lack of knowledge on your part. Maybe it is something that has not yet been described. A good pathologist is about having an open mind and looking beyond the clinical expectation.

Pathologists need to have patience and take a methodical approach to their work.

A very difficult thing in surgical pathology is to express in words the mental process you use in order to reach a diagnosis, because to some extent, it is instantaneous recognition at a subconscious level. Yet, you have to be skilled at putting what you’re seeing down the microscope into words. When you read a pathology report you should be able to picture what the author of that report is seeing and understand their interpretation.

Microscopic examination of tissue is definitely an art form, and it’s being able to put together pictures in your mind. Even when you may just see one corner of a picture in your biopsy, you have to be able to put that into the whole picture of what’s going on in the organ. By appreciating the patterns and the things that are changing in the tissues, and then bringing in additional scientific information, such as gene expression in the tissues, you can build both the artistic and scientific picture that helps you understand the disease.

The common thread throughout all of these comments from professionals in the field is that the best pathologists combine science and fact with art and intuition. They are keen observers, thorough thinkers, and methodical builders.

The road to becoming a physician, in general, is long and challenging. Choosing pathology means accepting this path to what is a very particular medical career – one with limited patient contact, but with unlimited potential to contribute to patients’ treatment and recovery.