Jared N. Schwartz, MD, PhD
We will always reach for a ‘dispositional’ explanation for events, as opposed to a contextual explanation.
—Malcolm Gladwell, The Tipping Point
I grew up in Youngstown, Ohio, a steel town and a melting pot. My father’s grocery store was twice burned down because he refused to cooperate with the local hoodlums. Eventually, they realized he couldn’t be intimidated and found another pay phone for their bookies. I guess the gangsters respected my dad in their way; after the second torching, they left him alone.
When we were small, my brother and I loved to hang out at my grandfather’s tailor shop on Saturday afternoons. Policemen and firefighters were in and out all day, picking up uniforms that my grandfather repaired under contract with the city. It was a busy, fun place; there was a lot of banter. We stayed out of the way, but we didn’t miss much.
In junior high, I wasn’t big enough for football or basketball, but I was involved in gymnastics and judo and had earned a green belt by the end of ninth grade. The summer before high school, I was elected secretary of the local judo club. This wasn’t a big deal but they sent a picture to the local paper. Newspapers didn’t have color back then, so my green belt came up black.
It was a tough school, so I was pretty surprised on the first day when kids I didn’t even know came up to me to say they’d seen my picture in the paper. It spread throughout the school. “Watch out for Schwartz,” they were saying. “He’s got a black belt in judo.” I didn’t see any reason to argue with them.
I could have corrected those kids and spent the next three years fighting for my lunch money. But I’d had good mentors. I’d seen enough to appreciate the temporal limits on a window of opportunity and the value of trusting your instincts. And I knew a good gamble when I saw one.
I had a great time in high school, got along with everyone. In the grocery store and the tailor shop, I had learned useful things about perception and playing to role. I had learned that others would see me as I saw myself. I had learned that nobody could intimidate me without my permission. And I had learned to think twice about every opportunity—once about the cost of embracing that opportunity, and once about the cost of not going for it.
In the quote at the top of this page, Malcolm Gladwell is talking about what psychologists call the “fundamental attribution error.” We want to believe that human behavior is innate, he says, but most of our choices are situationally driven. We are not fundamentally introverted or methodical or even sociable with all people at all times; we rise to the occasion as circumstances demand.
All of us are evolving all the time, revealing talents and strengths that affect how we see ourselves and others see us. When we talk about the CAP transformation campaign, we are describing something that happens inside our heads. Reinvention represents a fundamental change in how we think about ourselves and how others think about us as a result.
This brings me to something I want to get on the table.
Some CAP members have asked me why I am promoting this transformation campaign. They don’t see the need to funnel so much energy into a massive cultural shift for our specialty.
I wish I could say that we had convened a blue-ribbon panel in an undisclosed location and agreed to change our way of practicing medicine. That we had studied the literature, written a white paper, and agreed that pathology needed to take a turn, shift gears, reinvent.
Sounds good, but it’s not true. Let me state unequivocally: Reinvention and transformation are welcome, yes. But pathology is not driving this. The circumstances in our environment, the pace of innovation, the extraordinary flood of new technologies—these factors are driving our transformation. Our task is to create a robust response, to rise to the occasion to protect our patients and advocate for their best interests.
Transformation is the tool that will allow us to survive and enable us to succeed. We will transform because we must. The pace of technological discovery is driving our evolution and reinvention. If our patients are to have the full benefit of emerging technologies, we need to step up to the plate, learn and teach the appropriate use of old and new tools for diagnosis and therapy, and create reliable measures to ensure patient safety when these tools are used.
The College will continue to press forward. But be clear about this: We are operating from the eye of the hurricane and the landscape has forever changed. Our work as physicians will take on a new and more powerful character. The pathologist of the future will be the integrator, the person responsible for evaluating, communicating, and keeping new knowledge in context. And it will be in that new context that we build protections for our patients and translational tools for our clinical colleagues.
This is a time to celebrate, but every window can close. Opportunities are ours to embrace, but these are collective endeavors. Transformation is not top-down. The College can provide the educational tools through the Institute for the Advancement of the Pathology Specialty; we can ensure multispecialty, multidisciplinary collaboration to develop the standards and best practices for new and old technologies. But at the end of the day, transformation will happen in each hospital, each laboratory, each patient encounter, each treatment team meeting. At the end of the day, transformation is in your capable hands.
Which should be no problem. Remember, you’re a black belt.
Dr. Schwartz welcomes communication from CAP members.
Write to him at firstname.lastname@example.org.