Saturday, April 07, 2007

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.


At 13:34, Blogger Dr Michelle Tempest said...

Dear Dr K, it's always good to read about a doctor enjoying their job and explaining why cutting training time will not benefit future doctors. I have added you as a link from my site (which is much over due - but a bit behind with my links). Thanks and Great work. Michelle

At 23:40, Anonymous Anonymous said...

I couldn't imagine Pathology being rewarding, but I remember a certain Consultant pathologist self discharging from our ward in order to recover at home instead. The same day she called the hospital Path department and got them to deliver a microscope to her home so she could look at some slides whilst she recovered.

That's dedication for you ;)

At 05:07, Blogger The Angry Medic said...

Re the comment above: Whoa, that IS dedication. (Or extreme nerdiness. In which case, she prolly went to Cambridge.)

Pathology IS exciting, not to mention bloody important for the progress of scientific medicine. I've prolly told you this already, but I'm planning on taking a Pathology subject next year for my option. Reading your blog helped :)

At 17:03, Blogger Dr K said...

Hi guys

Thanks for adding me to your links, Michelle. One of the advantages of the old SHO system was the chance to do a few different things if you didn't have a firm career plan and with MMC that's being lost which I think is a really bad thing.

I know a few pathologists who have a microscope at home so they can do a bit of reporting and some who go in at the weekend to do some. I think it's partly because when you're at work during 'office hours' there are often a lot of interuptions!

What does your pathology option involve, Angry? Is it more diagnostic with looking at patients' specimens, watching autopsies etc or is it more basic science orientated with mechanisms of disease, signalling pathways etc? I'm glad the blog has helped!

At 19:16, Anonymous Anonymous said...

If I were a pathologist looking for a research project, I'd collect temporal bones from sufferers of Meniere's Disease and drill them. Of course, I'd also have to drill lots of normals too.

At 19:19, Blogger Cal said...

Path is SO HARD!! *whines, in an irritating, high-pitched manner*

SooooOOOooooOOOooo hard!!

And I don't know... I think I've been traumatised enough by looking down microscopes at slides in A-level biology, where I had to pretend to see stuff that I couldn't even see!


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