Jared N. Schwartz, MD, PhD
Congratulations. You are now
graduates of law school.
Let me tell you what you are not.
You are not lawyers.
—David W. Detjen, 2007 commencement speaker
Washington University School of Law
I may never be able to decide what I enjoyed most about these two years as CAP president, but lunch will always be on the list. Whenever I visited a practice site or training program, I tried to schedule in some unstructured downtime with my hosts. In small rooms with big tables, residents and fellows told me about their training experiences, those newly in practice described how they envisioned their futures, mid-career fellows shared changes they were thinking about, and those with the most experience free-associated next steps. I learned a lot over sandwiches and sodas; the closer I came, the better you looked.
When people talk about health care reform, the political piece gets the most press, but within pathology, the change agent is technology, not politics. We have all heard alarmist reports in the media suggesting that our post-health care reform future will look like a running of the bulls, but most pathologists seem to recognize that we are in a position to be among those driving the change, not running from it. We have the expertise, tools, and systems-oriented worldview to shepherd fellow physicians and patients through the changes to come. We know we need to be part of the solution, that we have an ethical duty to accept the responsibilities that come with our training. We recognize that, as Moliére famously said, we will be held accountable for both what we have done and what we have failed to do.
Rapid advances in personalized medicine are driving this evolution and fueling the transformation of our specialty. Much of the technology that pathologists will be using a decade from now doesn’t exist yet, but we have seen the power of pharmacogenomics and molecular diagnostics; we know what is in the pipeline. It’s wonderful to be at the plate when progress and circumstances are conspiring so effectively to foster a pivotal role for our specialty.
This seems to be something that most pathologists grasp instinctively. For example, Gene Herbek, MD, practices at Methodist Hospital in Omaha, Neb., where he is medical director of its blood conservation program and transfusion service. Dr. Herbek will tell you straight out that he was very satisfied with his traditional approach to practice before all the talk about transformation from the College got him thinking. Over the past few years, and especially since he became CAP secretary-treasurer, Dr. Herbek has made some changes and become convinced that transformational pathology is no more than the next step on our evolutionary path. We have always been the knowledge managers, he says. We have always been those with the best grasp of technology. The only change is in the delivery.
New technologies are fun, he says, but transformation is mostly about attitude. The paradigm shift relates not so much to what we are doing as how we communicate about it. Instead of writing reports, the transformational pathologist picks up the telephone or walks down the hall. Instead of checking off a data point, he or she talks to clinical colleagues about test results, indications for further testing, and treatment choices.
I have also learned that enlightened thinking about the future of pathology often comes from people outside the specialty. Gregory Downing, DO, PhD, for example, practices critical care pediatrics nights and weekends in Washington, DC. This no doubt informs his work during the week as U.S. Department of Health and Human Services program director for personalized health care. Reliable evidence-based information management will be critical in the personalized medicine era, Dr. Downing says, and pathologists are widely acknowledged to be master knowledge integrators. Because we know well the value of molecular tests, Dr. Downing says, we are perfectly positioned to decide when they are employed appropriately and how relevant results are best applied. The long-term vitality of our specialty, he suggests, may be tied to our ability to integrate what we learn from evolving databases and apply what we know in population-based work to frame best practices.
Thomas M. Priselac, president and CEO of Cedars-Sinai Health Systems and chairman of the American Hospital Association board of trustees, is another expert with insights related to personalized medicine. Pathologists, he believes, will be in a position to create partnerships that will enable hospitals and hospital systems to share high-tech resources. In addition, he points out, the price tag for some of the more complex new tests will make thoughtful input on test ordering even more important than it is now. Hospitals will be held accountable in public ways for the quality and cost of services they provide, he says. Pathologists who can identify the best tests for specific diagnostic and treatment planning purposes will be extremely valuable members of the clinical team.
My last comment from a nonpathology source comes from my daughter’s law school graduation speaker two years ago. The quote at the top of this page struck me at the time as equally relevant to medicine and law. Graduating from medical school doesn’t make us physicians any more than completing residency and fellowship makes us pathologists. We grow into our professions, and the most fortunate among us will never stop thinking in transformational ways. Whatever the calling, we need never stop becoming.
On the subject of professional authenticity, I would like to leave you with an observation about the College as a whole. Just as a diploma does not make a physician, a Web site and headquarters office do not make a professional home. The trusses that support an effective association are bona fide member participation, honest dialogue, energetic leadership, and an excellent staff. The CAP has all of those things. The College is a powerful advocate for our specialty because so many of our members participate, volunteer, and contribute. Working with you and for you has been a great privilege.
My successor, Stephen N. Bauer, MD, will take office next month. I know that you will appreciate his many talents as much as I do. I look forward to taking part in our continuing transformation at large tables in small rooms.
Dr. Schwartz welcomes communication from CAP members.
Write to him at email@example.com.