When I was in medical school, I loved pathology. The visual learning and deep understanding of disease were attractive enough that after second year, I took an extra year before clinical rotations to work as a post-sophomore fellow, working as a resident cutting specimens and performing autopsies. I missed patient contact but it served as a great foundation for clinical medicine and my choice for a career in cancer care.
Now my colleague in Lowell, Dr. Lija Joseph, allowed me to collaborate with her and other pathologists to publish on a community-based program that brings patients and pathologists together. It is creating an exciting opportunity for pathologists to participate directly in patient-centered care.
During my career, pathologists have always been the “doctor’s doctor.” Deeply knowledgeable, dedicated to teaching and educating clinicians. Guido Majno, who inspired me to do the extra year in pathology at University of Massachusetts, spoke lovingly of how pathology was the trunk of the tree of medicine, connecting its roots in science to the clinical branches of medicine reaching out to help patients.
So why can’t pathologists teach patients and be the “patient’s doctor,” too? Doctor comes from the Latin docere, meaning teach. I don’t think we know how the patient-pathologist interaction fits into contemporary practice, but why not explore seriously and find out? Increasingly, many patients seek more information to better understand a cancer diagnosis. The early feedback suggests patients interested in the process found it very satisfying. Maybe hearing about it from a doctor without biases favoring one treatment over another can add value to more empowered patient decision-making.
It may also help us address misinformation. A cancer diagnosis often triggers a frantic effort to learn as much as possible, but it may result in exposure to online snake oil. A 2009 study from Dana-Farber showed cancer-related direct-to-consumer advertising decreased trust in treating physicians for 11.2% of patients surveyed while receiving cancer treatment. Social media has likely made it worse.
We will likely need all hands on deck to inoculate patients against cancer "fake news" with accurate information. Pathologists may provide some of our patients with questions that probe deeply into science to understand the disease, without necessarily wanting to know how it affects treatment. Maintaining trust in a multidisciplinary team is best when the patient knows we can provide him or her with an understanding of the disease, what tools we have to help, and how to deal with the uncertainty coming with a cancer diagnosis. The same may apply for radiologists.
New perspectives also may bring new innovations. It wouldn’t be the first time pathologists worked with patients. Sidney Farber used his deep knowledge of cancer to help research and develop aminopterin chemotherapy for pediatric acute lymphoblastic leukemia. Before the last half-century, pathologists were more involved clinically. As molecular medicine gets more sophisticated, could a 21st century revival of pathologists in patient care bring new breakthroughs from a different perspective that surgeons, medical oncologists, and radiation oncologist just don’t have?
I don’t know. But the pathologists I know seem excited. Not all patients will want to meet and learn more. But maybe redesigning the scope of practice for the doctor’s doctor can improve cancer care. What do you think?
Denis Brin Hammond, MD, FASCO
Nov, 24 2018 10:39 AM
Great article. Thanks for this initiative. Everything we do in medicine that breaksdown silos and brings the patient closer to the doctor is a good thing. Thanks again, Denis B. Hammond, MD FASCO
Matthew S. Katz, MD
Nov, 26 2018 7:36 PM
Thanks, Denis! Credit to my creative colleagues in pathology, who wanted to turn the silos into bridges. I agree that if we can bring patients and doctors closer, we can accomplish more to improve health and provide the support patients deserve.
Dec, 02 2018 10:27 AM
As happens daily in doctor-patient relationships, the patient is taught not to ask questions, not to explain his symptoms completely, and not to request the rationale for his diagnosis. The input of the pathologist (and radiologist) is often essential to a a proper diagnosis, yet rarely is the patient given those report, and rarely access to the reporting individuals. Patients who are urged to ask for such reports and help in reading them are often shocked to find that the referring doctor has failed to note the subtype of their cancer, thereby treating those patients inappropriately. Other doctors dismiss the findings of the radiologist concerned that a mass is malignant, which leaves the patient falsely assured that he is not at risk, nor in need of further monitoring. As a final blow to the patient and his confidence in the doctor and the medical system is the assumption that the patient is not capable of understanding these reports.
Patients can become capable of understanding these reports and the impact on their health care. However, the denial of access to their own data and the barriers created by their own doctors is a betrayal of trust. No wonder the quacks, charlatons and purveyers of magic cures have such success with desperate and ill-informed patients.