Fan Mail

I've had a handful of readers over the past couple of years e-mail me to ask me questions about pathology and advice about medicine but no one, until last Thursday, has ever prefaced their question as "Fan Mail." I was tickled pink. A first year medical student from a far away institution asked this, and kindly allowed me to answer in a post:

"My question for you is, are there times when you wished non-pathologist physicians remembered more about histology? What would you like them to know?"

The short answer is this: NOTHING. That's job security, right there, in an age where everyone is stepping on everyone else's toes. Radiologist doing surgeon's jobs, interventional cardiologists threatening the cardiothoracic surgeon's lifestyle, general surgeons delving into plastics, etc. etc. Nothing makes me happier than when a radiologist peers into the scope while I am doing a wet read on a lung biopsy and acts like it is all voodoo. Or when a gastroenterologist comes to the lab to look at a biopsy and I can tell, even when they act like they understand what I am describing to them, they really haven't a clue. I'm certainly not claiming superiority, here. When a patient starts to hemorrhage during a lung biopsy, or when it comes to treating the many diseases that I diagnose, I haven't a clue. That's not my job, and I am not interested in any of it unless it helps me help the patient. I like to know the implications of my call, that is very important - if I upstage this cancer what will it mean for the patient? Extra chemo? A grimmer prognosis? But beyond that, I have little interest in the details, I have my own wide scope of practice maintain current knowledge in, and that already stretches me to the limits.

In a subsequent e-mail the first year is lamenting over an upcoming histology test, but simultaneously pleased with her status as a first year med student - we were all happy miserables, in med school. I hated first year histology. It was one of my few B's in medical school. Those old neck-breaking 1960's scopes with blurry eyepieces staring down onto old, overused slides - that was a nightmare. My first month of pathology residency confirmed that I retained nothing - I used to take random slides from my autopsy cases to test myself on normal histology. I still remember mixing up the pancreas and the pituitary gland. I think the first couple years of med school are important - but especially the first year seems to be a test of endurance, much of it is not really applicable to daily practice. Biochemistry about did me in, especially since I was a psychology major in college. Since I have graduated from my med school, they have re-vamped the curriculum to a systems-based approach, which I hope is less abstract than our disjointed basic science review.

My second year of medical school was better - everything seemed more practical. That is where I realized I had a talent for pathology. I was an "upper quarter" student, but was rarely at the top of the class. This changed when I took pathology - a two semester course. There was a bulletin board where all of our grades were posted next to our "super top secret" numbers that designated us, a number known only to the individual. The Wailing Wall. I still remember how long it took me to find my own number on the first pathology test - searching for my grade. After many frustrating, anxious minutes I finally found it - at the top. I was standing in a throng of med students. Someone said, "Who is that? Who made the highest grade?" I smiled quietly, still in utter shock and amazement, and slipped away. I was never at the top before, but it was consistent for me, in pathology. So although my route was circuitous - I had an ophthalmology residency in the bag, I was glad that I came to my senses because this is clearly my calling, and I am happy.

Thanks much for the "Fan Mail." It made my day! And good luck on your histology test, J! It is a means to a, hopefully wonderful, end. You never know. You might have a knack at it.