Is it rewarding?

Before I started to specialise in pathology nobody ever asked me this question. Now even other doctors ask me if pathology is rewarding. Is this because people, including other doctors, think that being a doctor (translation: seeing patients) must be rewarding and that being a pathologist (translation: not seeing patients) might not be?

What surprises me is that anybody thinks I’d be doing the job if I didn’t find it rewarding. If I preferred seeing live patients I wouldn’t have switched from the specialty I originally started training in after my house jobs; and if I decided I didn’t like it I had given up by now and be doing something else like the author of this article in the BMJ.

Some people (maybe the ones who thought up MMC?) think that my years of training in something other than pathology are a waste of time. They think junior doctors can make do with a quick run round three different specialties, probably not of their own choosing, and then be propelled straight into rush-through training in a specialty they may never have done since a 2 week placement in med school.

So has my previous training made me a better pathologist? Well it didn’t really help with things like how to do an autopsy, use a microscope or look at histological sections. What it did do was show me how difficult it can be to make a clinical diagnosis, the wide range of presentations there can be for a single illness, how to pick up clues from the history and external examination, when and how different pathology specimens are taken and what clinicians want to know from them. Being a good pathologist isn’t just about looking down the microscope, it’s about looking at the whole clinical picture in conjunction with the histology – this is why we often complain about a lack of clinical information on pathology requests.

My previous experience has, I think, made me a better pathologist than I would have been if I’d come into pathology straight from house jobs. It also showed me, as the author of the BMJ article found, that sometimes you have to try something for more than just a couple of months to be sure it is or isn’t for you.

So having tried something else I can say that pathology is definitely rewarding. You get the same diagnostic challenge but without having to be up all night. You can drink your coffee while working (maybe not in the mortuary!), do something practical like cut-up and autopsies to get out of the office for a bit and there’s always the MDT if you want to argue with/talk to other clinicians. The main advantage is that every specimen is a sort of ‘virtual patient’ meaning you can do something to help patients all over the hospital every day by providing a verdict on their specimen; which is what medicine is all about.