Jared N. Schwartz, MD, PhD
Yes, the race is long—to finish first,
first you must finish.
Garth Stein,The Art of Racing in the Rain
The take-away from this year’s meeting of the International Liaison Committee of Presidents (ILCP) was that the challenges of modern pathology are consistent across cultures, health care systems, and methods of payment. Digitization has been extremely helpful where staffing shortages frustrate consultation, enabling those in remote areas to obtain a second opinion from a pathologist across the continent. In some ways, these pathologists are farther along the high-tech track than those of us with the luxury of on-site backup. In sum, the world is getting smaller and spinning faster.
I traveled directly from the ILCP meeting to CAP ’08 in San Diego, where energy and excitement about our transformation campaign were evident among practicing pathologists and residents alike. Mara Aspinall, former president of Genzyme Genetics, gave a great keynote. Now on sabbatical at the Dana-Farber Cancer Institute and Harvard Medical School, Mara Aspinall addressed the ways that personalized medicine will affect pathologists and patients. She talked about why pathologists should be at the center of the revolution in diagnostics while acknowledging the barriers some pathologists have identified. After acknowledging those concerns, she dissected them one by one and made an airtight case for personalized medicine as a vehicle for rewarding, meaningful, and important opportunities for pathologists.
She identified the threats associated with personalized medicine: payers who wonder about cost, regulators who don’t know how to respond to the availability of complex new tools, and pathologists who fear that personalized medicine will make them obsolete. She acknowledged that the world is changing, that new skills will be needed and new responsibilities will emerge. Then she urged pathologists to reach for new roles, to be proactive in evaluating the new tests, to become the “educators supreme” within the hospital. She called upon us to take ownership of the data, how it is used for research, how it is managed and shared in the electronic medical record. Then she sent us out, empowered, grinning, and ready to learn.
Which is what CAP ’08 was all about, of course. I won’t get into the coursework, other than to say that it was typically stellar. More than 1,175 pathologists registered to attend CAP ’08; resident attendance set a new record. Along with discussions around our campaign for transformation of the specialty, we formally launched two key initiatives: the Institute for the Advancement of the Pathology Specialty (chaired by Mary Kass, MD), and the Pathology and Laboratory Quality Center (chaired by Elizabeth Hammond, MD).
At the House of Delegates meeting, Dr. Kass presented the rationale for the Institute, weaving into her talk some wisdom from a novel titled The Art of Racing in the Rain, whose main character, Denny, races cars, and whose narrator is a highly observant and philosophically inclined dog named Enzo.
Enzo observes that champion racers prepare exhaustively to drive in all kinds of weather. This practice eliminates fear of a crash on wet pavement, allowing the driver to focus on the goal. “The car goes where your eyes go,” Enzo says. “That which you manifest is before you.”
Mary’s wonderful talk got me to thinking about the wealth of talent within this organization. A past president of the College, Dr. Kass now heads the CAP Foundation board and is a driving force behind Futurescape. Her chairmanships have included the Council on Scientific Affairs, the Credentials Committee, the Council on Public Affairs, and the planning committee for the annual meeting. Dr. Hammond, who will head up the Center, was a catalyst for our HER2 collaboration with the American Society of Clinical Oncology and is now coordinating another ASCO/CAP partnership to write a guideline for estrogen receptor testing. A former member of the Board of Governors, Dr. Hammond has chaired the Curriculum, Education, and Cancer committees.
Drs. Hammond and Kass have the experience, passion, ability, and wisdom to guide construction of the CAP Institute and CAP Center. Most important, they have the vision of transformational pathologists. We will go where their eyes go.
The Center and the Institute are critical pieces of a transformational mosaic now under construction. Transformational pathology will take time and work and what the kids call “attitude.” Our goal is to bring about a behavioral change across medicine so that our patients and clinical colleagues will routinely come to us for guidance.
Emerging diagnostic technologies with enormous impact on patient treatment planning but a narrow window of opportunity will increasingly redefine what is meant by “patient safety.” The power to make a definitive diagnosis and initiate targeted treatments for patients whose disease is rapidly progressing will have a dramatic impact on treatment planning. Clinical colleagues may be reluctant to embrace new tests, feel that they are too prescriptive, worry that they are yet unproven. It will be our task to help them make proper use of the promise of personalized medicine, and if that is to happen, they must begin to regard us in what may be an unaccustomed light: as their go-to educators, information integrators, and guides through the thicket of testing alternatives.
Early on in The Art of Racing in the Rain, Denny finds a girlfriend, Eve. Enzo realizes he is hostile to her because he is afraid he will be replaced. After he resolves to embrace his fear and change his behavior, Eve warms to him. “I allowed Eve to regard me differently,” Enzo says, and the two become the best of friends. “While I cannot say that I am a master of my own destiny,” he concludes, “I can say that I have experienced a glimpse of mastery and I know what I have to work toward.”
Sounds like a plan.
Dr. Schwartz welcomes communication from CAP members.
Write to him at firstname.lastname@example.org.