Getting Out From Behind the Paraffin Curtain

A must-to-read Editorial on pathologist's career with a focus on the political efforts needed  to achieve a good work quality and the consideration deserved among clinician colleagues and hospital administrators. To get out from behind the paraffin curtain.

Many pathologists, especially those who maintain contracts with hospitals and other providers, possess keen political skills. They have learned how to keep clinicians happy with the accuracy and alacrity of laboratory services, administrators satisfied with efficiency and financial performance, and technical personnel content with working conditions. [...] As pathologists' careers develop, they are often called on to be leaders. Some are uncomfortable in leadership positions, their careers to date having been founded mostly on individual achievement. The reluctant leader should not be dissuaded by lack of leadership experience. Often the best leaders are those who did not seek out the position but developed their own style as they adapted to the demands of the position. [...] Other challenges include learning to delegate (and follow up on delegated tasks), providing encouragement and inspiration to team members (some of whom may be quite hard-boiled and cynical), and occasionally standing up for the team when it is under assault by powerful factions, including clinicians and other clients. This last challenge takes no small measure of courage and equanimity. [...] The pathologist/politician/leader is commonly confronted by ethical issues. We typically serve multiple masters, including patients, administrators, clinicians, and regulatory agencies. We need to be sensitive to their conflicting agendas. Medical ethics is a complex field [...]  Nevertheless, building a reputation for incorruptibility does foster trust, and trust is fertile ground for opportunity.

Edward O. Uthman (2014) Getting Out From Behind the Paraffin Curtain. Archives of Pathology & Laboratory Medicine: January 2014, Vol. 138, No. 1, pp. 12-13.

Happy New Year 2014.

Talking to patients about a diagnosis of malignancy in a FNA clinic setting

Informing patients of a cancer diagnosis is never easy and requires skills not systematically taught in US medical schools and residency programs. The absence of a universally accepted best method for delivering bad news presents an additional challenge. In specialties like pathology, practitioners typically have little patient contact. Training programs, including Cytopathology fellowships, in which patient encounters are routine during fine-needle aspiration (FNA) procedures, offer minimal education on this topic. Formal teaching in this area is lacking, even in medical fields where physicians frequently must present bad news to patients, such as palliative care and oncology.Without adequate training, delivering bad news to patients is made more difficult for physicians in all fields, and the FNA pathologist in particular may be reluctant to participate in patient care beyond obtaining the FNA sample. [...]

Pathologists are integral members of the clinical team, and cytopathologists in particular need to develop communication skills for discussing disease with patients. Deciding whether and how much to tell a patient about the FNA diagnosis is subject to personal judgment and the unique interaction between a patient and pathologist.

Ly, A. (2013), Talking to patients about a diagnosis of malignancy in a fine-needle aspiration clinic setting. Cancer Cytopathology, 121: 339–340.