How glamorous is your job?

Just as some internal organs are more ‘glamorous’ than others, some diseases and some medical specialties are more ‘glamorous’ than others. Hearts and brains are glamorous organs. Breast cancer is a glamorous disease: emotive, well-publicised and attracting a lot of funding. Cardiothoracic surgery and neurosurgery are glamorous specialties, as is transplant surgery. Breast surgery is much less so, and despite the brain being an organ with so much mystique, psychiatry is a distinctly unglamorous area. It is appallingly underfunded and has few high profile people fighting its corner. The realities of NHS psychiatric services are well described at Trick-Cycling for Beginners.

Pathology has a dual personality. Forensic pathology, a relatively small field of pathology practice, is very glamorous, gritty but glam. For many years charismatic and often enigmatic forensic pathologists have appeared on our TV screens, characters such as Quincy and Sam Ryan for example. Most detective dramas have their own pathologist lurking in (usually) an impractically dark mortuary. Many of these portrayals are hopelessly unrealistic.

No wonder 30% of the British public think pathologists run criminal investigations and only 9% know we diagnose cancer, according to a survey done for the Royal College of Pathologists.

More recently the series Death Detective on BBC3 gave a more realistic insight into the work of forensic pathologist by following the work of pathologist Dr Dick Shepherd. This showed a less glamorous side to the job with real internal organs and real blood, but few high profile murder cases. The real work shown included more cases of the sad and unfortunate who die alone, on the street, in questionable but not always suspicious circumstances.

The mostly glamorous image of the forensic pathologist contrasts with that of the histopathologist. We seemed to be pretty much under the radar until the organ retention crisis occurred and turned us into heartless body snatchers. Hate campaigns against paediatric pathologists, even including the bullying of their children, led some to leave their jobs. The specialty of histopathology has been in crisis with the number of consultant vacancies in England and Wales in 2004 standing at over 200. The organ retention issue is not the sole cause of this but it hardly helps.

Despite considerably outnumbering forensic pathologists, histopathologists are rarely seen on TV. I can only recall two: Professor John Lee who appeared with Gunther von Hagens (who is an anatomist, not a pathologist) on Autopsy: life and death, Anatomy for Beginners and The Autopsy, and the very brief appearance of a neuropathologist on a documentary about a neurosurgeon.

Perhaps forensic pathology gets is glamour from its association with crime – dangerous and fascinating. In comparison, diseased organs and microscopes may not seem so exciting. The vast majority of patients never meet or even know about the existence of the histopathologist who makes the diagnosis on their tissue sample. They may only have two images of pathology, the glamorous crime-stopping forensic pathologist and the organ-snatching histopathologist. Neither of these is accurate.