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Attributes of a Pathologist

What makes a good pathologist?  First of all, I think you have to be good
at pattern recognition... 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?
  Must I do some more special stains?  Must I show it to somebody else?
  Must I read up in the books about it?"  And you have to be quite determined
to find out

Paola Domizio (UK)

  More quotes on Attributes of a Pathologist

Pathologists are united in the view that having a strong visual memory – above all a talent for pattern recognition – is a crucial attribute of a good pathologist.  In fact, as Juan Rosai comments, “if we knew exactly how to test this quality, that would be very useful, because then we could tell people, ‘You are not really fit for this business’."  It is striking how many of the interviewees cite a passion for art among their outside interests.  

You have to be able to build pictures in your mind“You have to be able to build pictures in your mind.  That's why the training takes a long time,” says Ken Hillan, since pathologists must develop this innate visual ability and marry it to rigorous scientific learning. “There's no doubt [pathology] is very much based in science.” In addition many interviewees cite the need for observational skills, attention to detail, patience and a methodical approach to work.  “Probably the most serious fault, if you like, in a potential pathologist,” says Paola Domizio, “[is] not being thorough enough”.

Domizio goes on to point out that since the main means of communication is through written reports, “you have to have a skill in putting what you're seeing down the microscope into words”.  

Juan Rosai, noted for identifying new disease entities, stresses that alongside these physical attributes pathologists also need to have ‘imagination’ and ‘conviction’ and should not be afraid to question.  “That's one of the things I have been telling people over the years: ‘If you see something that's doesn't fit any disease you know or that is in the books, don't assume automatically that you don't recognise it because you are no good.  Maybe it is something that has not yet been described’." 

don't assume automatically that you don't recognise it because you are no goodJames Ironside makes a similar point: being a good pathologist is “about having an open mind and looking beyond the clinical expectation”.  He tells the story of discovering the new variant of CJD, and how important both good pattern recognition and being open to new interpretations were on this occasion.

Rosai explores the challenge of understanding what goes on when a pathologist makes a diagnosis, “because it works to some extent at a subconscious level”.  He and Francisco Gonzáles-Crussí both tell the amusing story of an intriguing and ultimately unsuccessful experiment, involving “some technological gizmo”, to deconstruct the process of diagnosis.

 

Key interviewees: Kenneth Hillan, Jeffery Taubenberger, Elaine Jaffe, Juan Rosai, Francisco Gonzáles-Crussí, Paola Domizio, James Ironside

See Also: Motivation

 

QUOTES

Bill BassYou 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.
 - Bill Bass (USA)


Ken HillanThe histopathology diagnostic microscopy 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.  Being able to do that visually is one of the key things about histopathology. But there's no doubt that it's very much based in science... 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 the scientific picture that helps you to understand disease.
 - Ken Hillan (UK and USA)

Paola DomizioYou have to be good at written communication, believe it or not, because your way of communicating what you think about a particular case is through the written word. When you read a report you should be able to picture what the pathologist who's written that report is seeing, and agree with their interpretation.  And actually not all histopathologists are very good at that.
 - Paola Domizio (UK)

Elaine JaffeI think that you have to be born with a certain visual aptitude.  I can tell the first month when I sit down with a resident whether they have got it or not.  Unfortunately I feel there are some people who may choose pathology not really knowing what it is, or not having tried it, that are not well suited to it. Actually a colleague of mine told me that one question she always asks residency applicants is about their hobbies, and if they like art or photography in particular she feels they are more likely to be good pathologists than if they have other orientations. 
 - Elaine Jaffe (USA)

Sebastian LucasYou learn by having a prepared mind... [And] you have to face the fact that usually the first time you see something really big and different you'll get it wrong.
 - Sebastian Lucas (UK)




Juan RosaiA very difficult thing in surgical pathology is to express in words the mental process you use in order to reach a diagnosis, because it works to some extent at a subconscious level.  People will show you a case, you realise immediately that it is an alveolar rhabdomyosarcoma, so you make that diagnosis. But if they ask you, "Why did you say that?" then you have to think!  You go ahead and list the reasons or criteria, but you haven't thought of them, at least consciously, while you were looking.  It was just an instantaneous recognition.
 - Juan Rosai (Argentina, USA and Italy)

I happen to have a good memory, and that helps, no question about it!  Visual memory is very important in this field... Like playing tennis or chess, you can certainly improve and play a decent game by practising and taking lessons, but if you have no inborn talent you will never be first rate. I think the same is true of surgical pathology. There is no question that some people have a better ‘eye’ than others.  There are pathologists who have been in the field for 40 years or more and who have tremendous experience but will never go beyond a certain point, so that a third year resident with a good ‘eye’ will see something that they have not.
 - Juan Rosai (Argentina, USA and Italy)

Francisco Gonzáles-CrussíDiagnosis by microscopic examination…is largely dependent on sight, and there are individual differences there.  There are some people who, as they say, 'have the eye'. And other people who may have tremendous abstract reasoning; they may have excellent memory and be excellent in many aspects, but don't have a 'visual intelligence' and so they don't become very adept at the microscopic interpretation because they seem to have like a physical difficulty.
 - Francisco Gonzáles-Crussí (Mexico and USA)

In other words, in addition to the skill in interpreting and all that, the first thing that you need is to like it.  Because some of those microscopic fields have an intrinsic beauty to them. I'm sure that if you look at the abstract art that they display in the museums, and you look at a Papanicalaou smear (a Pap smear) stained with all the dyes that they use, some of those images could be framed and put side by side… So there you are, that's another aspect of pathology that people don't usually mention. I think you have to have a good visual ability in addition to a liking for the intrinsic beauty of microscopy itself.
  - Francisco Gonzáles-Crussí (Mexico and USA)

Maesha DeheragodaI like design in all its aspects.  Beautiful furniture and things like that.  Our home is filled with canvasses.  We have many friends who own art galleries, and we’re always getting interested in new artists. I think that sort of lends itself to pathology because it is a very visual field.  You’re constantly looking at patterns and colours, and the relationships of them all to make a diagnosis.  I find that many pathologists I know are very good artists or love the artistic world.
  - Maesha Deheragoda (UK)





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