Friday, November 03, 2006

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.


At 22:45, Blogger Shiny Happy Person said...

I feel your pain.

At 09:35, Anonymous Anonymous said...

'The vast majority of patients never meet or even know about the existence of the histopathologist who makes the diagnosis on their tissue sample. '

Ditto any work done in laboratories, as far as I can see. Do people think that straightforward (if you know what I mean) doctors do all the work that's done in laboratories?

Only found your blog yesterday, and am very pleased to have done so.

At 16:16, Blogger Dr K said...


You're the first person to post a comment so please award youself a drink/bar of chocolate/day out! It's amazing how difficult it can be to explain your specialty to people and for them to understand that you're doing a job just as speciallised and important as that of a heart surgeon etc. I don't think pathology feels the financial pinch as much as mental health though.

Hello anonymous, glad you like the blog. I'm not sure most people realise that it's actually doctors who look at their samples. I've heard quite a few people say that they want to become pathologists (in the sense of doing autopsies) and then you discover they don't even know you need to go to med school first. If the sample goes to "the lab" then maybe they think the biomedical scientists make all the diagnoses. Or maybe they think it's all done by fancy machines without human input? I'm not really sure.

At 22:00, Anonymous Chromatin said...

I think it's the 'fancy machines' option myself.
Having been on the receiving end of various comments from the public - apparently I must be a nurse.
Closely, followed by 'ooh, the doctors do that'.
Apart from practice nurses, who think the machines do it all. Of course in Haemachemistry, they'd be right! ;-)
No one seems to know that BMSs exist.
Well apart from yergoodself of course.

At 17:09, Blogger Dr K said...

Very true, chromatin, if you're female and work in a hospital you must be a nurse! Do you think people would be disappointed if they knew it was just some human looking at their sample rather than a high tech machine?

At 22:57, Blogger Chromatin said...

Well, given my experience of showing disappointed looking practice nurses round the lab, yes.
Otherwise I think it depends on whether the public are from one of two completely opposing schools of thought.
1) its computer/high tech equipment, therefore it must be better than these lazy/stupid/ignorant/mistake-ridden humans.
2) not a machinery! Haven't you seen 2001/Terminator etc etc.

Having said that, automation appears to be where cytology in particular is heading, what are you views on that?

At 19:21, Blogger Dr K said...

Personally I'm not fond of cervical smears so I wouldn't object too much to automation from that point of view, although machines, if they are ever accurate and reliable enough, are always going to throw up cases that need to be reviewed by a human anyway, plus I imagine there would have to be some kind of review of random cases to check the machine's perfomance. I think producing a machine that can genuinely replace a human cytoscreener/pathologist would be difficult - maybe it wouldn't get bored or tired but it wouldn't have gut feeling either - an important aspect of diagnosis!


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