want from pathologists is
quite simple. Every last one desires something different.
the short answer, unfortunately,” says Robert J. Homer, MD,
PhD, associate professor of pathology, Yale University School of
Medicine, and director of anatomic pathology, VA Connecticut Healthcare
Dr. Homer should
know. He’s one of three coauthors of “Clinicians Are
From Mars and Pathologists Are From Venus” (Powsner, et al.
Arch Pathol Lab Med. 2000; 124: 1040–1046), which
looked at how well clinicians understood pathologists’ written
reports. Which leads to another short answer: Not so well—the
investigators found that surgeons misunderstood pathologists’
reports 30 percent of the time.
really shook me up,” says another coauthor on the paper, José
Costa, MD, deputy director of the Yale Comprehensive Cancer Center
and director of anatomical pathology and professor of pathology,
Department of Pathology, Yale. “A third of my life is gone
in misunderstandings,” he says, only partly facetiously.
At the same
time, he couldn’t have been completely surprised. After all,
the study was born from his concern that he and fellow pathologists
were overly “pathocentric,” as he calls it. “As
pathologists we worry about the report, and we think about the report,
and always from the pathologist’s point of view,” he
says. “That’s not necessarily what our customers, the
physicians, want. And in fact, we found out that it’s very
difficult to get information across in a way that is easily apprehended
by the consuming physician.”
You hardly need
a study for that truth to dawn, however. Anyone who’s ever
worked in a laboratory knows pathologists and clinicians aren’t
always comfy bedfellows. Everyone has a tale. Clinicians who scribble
“rush, rush, rush” on every order, assuming the turnaround
time will stretch into weeks if they don’t goad the lab into
faster action. Pathologists who drop a note about a cancer diagnosis
in the mail, nothing e- about it. Clinicians needing tutorials in
the finer points of screening versus diagnostic tests. Pathologists
who struggle to explain that distinction.
go on forever, like a messy divorce, unleashing shock, disbelief,
and anger, all giving way eventually to a resigned tiredness. Underneath
this sea of woes lies the real conundrum: How can pathologists make
sure clinicians get what they truly need? Which brings us back to
Dr. Homer’s observation—it depends on the clinician
and the pathologist.
aren’t reluctant to say what they want.
In a series of interviews with CAP TODAY, nearly a dozen made their
feelings clear about what they’d like their pathologists to
They also emphasized
that much of the time, they’re already getting what they want.
“Pathologists are not a frustrating part of our experience,”
says Gretchen P. Purcell, MD, PhD, of Duke University Medical Center.
Still, if Yale
surgeons misunderstand pathologists’ reports 30 percent of
the time, is it going out on a limb to suggest there might be room
for improvement? In that spirit, here’s a sampling of physicians’
responses to the question, What do you need from your pathologists?
them what you’ve got. Seeing is believing, says Dr.
Purcell, chief resident in general surgery and assistant research
professor of surgery and clinical informatics, Duke.
seeing the pathology is very useful to me,” says Dr. Purcell.
Yet unless a case involves cancer, such viewings are not the norm.
admits seeing slides for every case would overwhelm her. But she’d
like to see more than she currently does—unusual cases, for
example, or those with equivocal findings. “I’m not
a pathologist, nor do I profess to have any expertise in this area,”
she says. “But it is useful when someone says, ‘This
is unusual,’ and you look at it yourself. The more you look,
the better you feel in making a judgment when the findings are equivocal.”
them into your world. Harold C. Sox, MD, editor of the
Annals of Internal Medicine, says he enjoyed a spirited
relationship with pathologists during 30-plus years of clinical
practice. “I’ve always appreciated a pathologist who
imposed on me to come look at a biopsy slide, who said, ‘The
urinalysis on your patient is pretty exciting—can you come
up right now and take a look at it?’” he says. “I’m
in favor of pathologists crowding clinicians a bit to come see interesting
things and broaden their education, to get them out of the clinic
and learn something.”
should welcome being pushed as well, says J. Stephen Jones, MD,
staff urologist at the Cleveland Clinic. He likes that at his institution,
when he or his clinical colleagues ask to look at a biopsy, the
pathologists “bend over backwards to make sure we understand
why they’re reading the biopsy the way they are.”
they know it’s cancer, they’re just not willing to go
out on a limb,” Dr. Jones continues. “And that’s
when I like to be able to challenge them. Sometimes they’ll
say, ‘No, there just isn’t enough to say it’s
cancer,’ and other times they’ll say, ‘You know,
you’re right, we’ve looked at it again, and we’re
ready to commit to saying it’s cancer.’ Having that
dialogue is obviously crucial.”
get out of your own world as well. It’s a delicate
matter, one clinicians raise consistently but gingerly. Begged one
physician: “Find a way to say this so your readers don’t
beat the crap out of me.”
As some clinicians
see it, pathologists’ professional lives are built around
scheduled procedures. Pathologists could be tonsured monks, for
all the times they get out of the lab. Yes, the age-old myth persists:
They think you chose pathology, in part, because it’s more
controlled, more contained, than other specialties. Clinicians on
the front lines of patient care lay claim to no such luxury. “It
can be infuriating. You can go long periods of time without much
happening, and then suddenly it’s a deluge,” says Lee
A. Hebert, MD, director of the Division of Nephrology and professor
of medicine, Ohio State University. Pathologists who don’t
rise to the occasion just make matters worse. A clinician who suspects
a patient has TTP, for example, doesn’t want the pathologist
to respond with, “Oh, sure, I’ll look at it Monday,”
says Dr. Hebert. Nor is “Hmmm, really? Are you sure about
that?” a helpful reply.
have to learn to not find reasons not to do something,” Dr.
Hebert says. “Even if it’s 11 at night, or 1 in the
morning, you want to hear, ‘That’s my job; I’ll
be right there.’”
aren’t the only reluctant warriors in medicine, Dr. Hebert
acknowledges. But now, more than ever, there’s reason for
pathologists who drag their feet to change their ways. “There’s
an increasing movement for pathologists to take on clinical activities,”
says Dr. Hebert, pointing to pathologist-directed plasmapheresis
services as one example of this shift. “So we’re expecting
pathologists will become more willing to be there for the patient
at times inconvenient to themselves and their families.”
speaking in tongues. “It’s very simple what
we need from our pathologists,” says Gary Falk, MD. “Expert
pathologic consultation, using a standardized, acceptable terminology.”
portion is critical, he says. “That’s the single biggest
problem—that pathologists don’t use standardized terminology.
It creates an incredible amount of extra work for clinicians and
pathologists, and it increases health care costs.”
Dr. Falk directs
the Center for Swallowing and Esophageal Disorders at the Cleveland
Clinic’s Department of Gastroenterology and Hepatology; he’s
also an associate professor of medicine. Not surprisingly, he picks
Barrett’s esophagus to make his point. Though specific terminology
exists for the dysplasia classification as well as intestinal metaplasia,
“Pathologists get it wrong all the time,” he says. “They
don’t use the correct terminology for dysplasia, and they
don’t state in the pathology report whether they see intestinal
metaplasia or not.” Accordingly, Dr. Falk sees his fair share
of patients who come to him in a panic, having been told—mistakenly—that
they’ll die of esophageal cancer. “When in fact they
don’t have Barrett’s esophagus. They’ve never
had Barrett’s esophagus. It’s because the pathologists
didn’t read the darn thing right. If they would use the right
terminology, a lot of these diagnostic inconsistencies would get
John Goldblum, MD, professor and chairman of the Department of Anatomic Pathology
at the Cleveland Clinic, says Barrett’s esophagus is defined as esophageal
intestinal metaplasia with an endoscopic abnormality. “Our job as pathologists,”
he says, “is to recognize intestinal metaplasia in a biopsy that the gastroenterologist
tells us is from the esophagus.” If the biopsy has Barrett’s, Dr.
Goldblum says, then the pathologist must comment specifically on the presence
or absence of dysplasia using the following classification:
- lP Negative
- lP Positive
for dysplasia. If positive, low grade or high grade.
- lP Indefinite
Dr. Falk is also irked by the way pathologists frequently report
on chronic active gastritis. “There’s no mention oftentimes
of whether the pathologist looked for H. pylori or not,
or if special stains were done,” says Dr. Falk. “Again,
it’s the issue that standard terminology, standard ways of
reporting information, isn’t there.”
to the point. It’s a dead-ringer for a line in a
country-western song: Make the bottom line your top line. This request
comes courtesy of Dr. Jones.
I usually want—and I think I speak for most clinicians—is
to be able to get the high points of any pathology report in a matter
of seconds,” says Dr. Jones. “Then I can go through
the text if I need clarification.”
Dr. Jones finds
that a bulleting system works well. A prostate biopsy report, for
example, would contain one line each for Gleason’s score,
location, tumor size, and percentage of biopsy that’s positive.
“I can go down the list, and I know just where to find each
piece of information,” Dr. Jones says. “Whereas if it’s
just in paragraph form, I have to sort through someone’s verbiage,
hoping that I interpret them correctly.”
Too much prose
adds confusion. “Help me out here,” Dr. Jones pleads.
“I don’t have time to read three paragraphs of a negative
report, to make sure that at some point in there it says that there’s
no cancer. I want something that says, ‘There’s no cancer.
The details are below.’”
fit the format just as well, Dr. Jones says. “I still want
that summary at the top: ‘Suspicious but not diagnostic for
cancer.’ I need that summary right off the bat, hitting me
on the forehead. And then I’ll choose whether I need to sort
through why they couldn’t tell.”
a point. Pinning pathologists down to an answer is a little
like watching Donald Rumsfeld spar with the press, some clinicians
school we probably would have preferred the true-false test, and
the pathologists would have preferred the multiple-choice,”
says Dr. Jones.
understand if something is equivocal,” he continues. “That
is an answer, and we’re willing to accept that. What we have
a hard time with is two paragraphs explaining that they’re
unwilling to say they don’t have an answer.” Instead,
he’d like pathologists to say—up front, of course—“We
have done everything we can do, and this is the best diagnosis we
a change? Let them know. When changing a test or adding
a new one, don’t keep clinicians in the dark, requests Maurie
Markman, MD, chairman of the Department of Hematology and Medical
Oncology at the Cleveland Clinic.
E-mails or a
paper trail announcing the change is one way to get the word out.
But face it: Both can get lost, or at least not read. A more direct
way is literally going to a staff meeting, says Dr. Markman. “That
way you’ll be able to have a direct discussion with the doctors
involved, and you can have a give-and-take about whatever questions
and answers come up.”
That also holds
true when changing report formats. “In our place the tests
change constantly,” says Michael Fischbach, MD, professor
of medicine and chief of the Division of Clinical Immunology and
Rheumatology, University of Texas Health Science Center, San Antonio.
“One week it’s reported in titers, the next month it’s
reported in units, and you’re not sure how they correlate.”
information in pathology reports will confuse clinicians if it’s
not introduced carefully. Says Dr. Markman: “If the pathologists
think there’s something new that they want to add—just
as when clinicians find something new that they think is relevant—meet
together and decide how to modify the reports so everybody understands
not every test is equal, cautions Dr. Fischbach. No amount of e-mails
or newsletters can make him remember a test has been changed if
it’s one he rarely orders. “You forget about it. When
you order it, that’s when you need to deal with the
information. Maybe it can be attached to the test results.”
numbers ... More numeracy in answers would improve care,
says Robert Badgett, MD, associate professor of medicine, University
of Texas Health Science Center, San Antonio. Important test results
should include information on the test’s sensitivity and specificity
in typical clinical populations, he suggests. “How many clinicians
are inappropriately ordering and applying the BNP assay to diagnose
heart failure because they don’t realize its specificity isn’t
strong at any cutoff level, and its sensitivity is strong only when
the BNP is less than 50 pg/mL?” he asks.
Or don’t. “On the other hand, I got to admit,
docs are real reluctant to have their answers in numeric terms,”
Dr. Badgett continues.
“For one thing, it takes some work to interpret the numbers,”
he explains. “And studies show that only three percent of
practicing docs and about 50 percent of teaching docs use sensitivity/specificity
when they’re trying to interpret tests.”
takes those numbers to mean that clinicians don’t want numbers.
“They see it as a burden.”
really, you probably should use numbers. Because as Dr.
Badgett points out, “There is research that shows if you give
them those numbers, they make better clinical decisions. A current
example is probably the BNP.”)
up the phone. OSU’s Dr. Hebert can recall a case
when he was told of a terminal cancer diagnosis by mail. “By
mail? Geez!” he says, still amazed at the delivery method.
Not that other
methods are necessarily more efficient. Dr. Hebert recounts another
case involving a pathologist who was performing a kidney biopsy,
working in conjunction with a radiologist. After the pathologist
had completed his work and left, the radiologist, in reading the
films, realized the patient had an aneurysm. The radiologist reacted
to this finding by recording a message on his Dictaphone—as
Dr. Hebert puts it, “leaving it to his secretary, the mails,
and interoffice help” to convey the message. “There’s
a 10 percent chance the report never got back to the doctor,”
he says. “If it does get back, and you’re going through
six inches of reports, and here’s this one talking about a
kidney biopsy under fluoroscopy—you’re barely going
to look at it. And buried in that is the note about the
Dr. Hebert became
involved “when the patient showed up six months later and
died in the ER because his aneurysm had ruptured.” The original
pathologist was subsequently sued; Dr. Hebert, who served as an
expert witness in the case, reports the radiologist defended his
actions by saying, “I told you—it was in the report.”
the responsibility to his patient ended when the words left his
mouth and entered a Dictaphone,” Dr. Hebert says angrily.
particular incident was tied to a radiologist, not a pathologist,
the point is well-taken: Make sure that clinicians receive critical
deeply grateful for calls,” says Dr. Hebert, who now gets
all reports of a malignancy by telephone. He also advocates telephoning
for panic values. “Our lab is really quite good at that. They
call you at 8 PM, after you’ve been in the clinic all day
and generated a bunch of labs. And they’ll say, ‘By
the way, Dr. Hebert, Mrs. Jones has a potassium of 6.6.’ And
they’ll have her phone number so I can follow up—because
they’re calling me at home. That’s hugely useful,”
Dr. Hebert says.
But for such
calls to be useful, they can’t be perfunctory. “We see
it all the time in the reports—‘Dr. Jones was called’—when
in fact, he wasn’t called,” he says.
shy away from e-mail, either. Phone calls may be ideal,
says Dr. Falk, “but I don’t think it’s fair to
ask them to do that all the time—everyone is so busy.”
Not every case
requires a call, agrees Dr. Hebert. “If it’s not that
urgent, an e-mail to promptly alert us is fine,” he says.
“The trouble with e-mail is, you’re never sure if the
person reads it. They may be gone for the day.”
At the Cleveland
Clinic, physicians receive an automatic e-mail notification as soon
as laboratory values or pathology reports are complete, says Dr.
Jones. “It saves me a lot of effort.” Though he may
call a pathologist on more urgent cases, requesting that they look
at a slide posthaste, routine matters don’t require constant
checking. “If I don’t have that e-mail, I know it’s
not ready,” he says.
Internet, for that matter. An active researcher in clinical
informatics, Dr. Badgett avows a strong interest in understanding
how clinical information flows. Specifically, he’s intrigued
by the question, How much information do clinicians want in their
found, he says, that so-called opinion leaders—those most
likely to change medical practices, either formally or informally—are
likely to want added information, such as original evidence. Teaching
physicians are likely to fall into this category, as are nonteachers
who strive to stay abreast of new developments. “But at the
point of care, I think they’re just going to want you to give
them the answers—the assay results, and its sensitivity and
specificity,” says Dr. Badgett.
says Dr. Badgett, the Internet and electronic medical records will
make it possible, perhaps even easy, for pathologists to provide
layers of information in their reports. In addition to including
a test value, they can also link to studies related to the test,
to the disease, or to both. This passive approach makes the information
accessible without overwhelming clinicians, he suggests.
information useful is another matter. “If you just throw out
a couple references that you think are probably pretty good, but
you haven’t done a good literature search and formally assessed
the articles, or worked out the sensitivity and specificity, then
people aren’t going to respect that work and use it,”
Dr. Badgett says.
Dr. Jones seconds
that notion. In fact, he dismisses most added information as useless.
“It just clutters up the pathology report when they put that
in. I know some labs routinely say, ‘The PSA is positive,’
and then it will give a reference—‘Catalona found that
22 percent of patients with this level of PSA had cancer,’
and things like that.’ Well, if I don’t know that already,
I shouldn’t be ordering that test,” Dr. Jones says.
consultant. Clinicians use this word freely when they talk
about you. To wit:
- lP “A
pathologist should be a consultant, not just someone who provides
a service,” Dr. Falk says.
- lP “We
are fortunate in that our pathologists have a good grasp of the
fact that they’re physicians, not laboratory people,”
says Dr. Jones. “They’re consultants.”
- lP “For
complicated testing, it should be more a consultation,”
says Dr. Fischbach. Surgical pathologists do it all the time,
he notes. “They work the whole thing up. That’s what
we need in clinical pathology.”
a report containing a positive antinuclear antibody test result
would include guidance on followup testing. “Of course everyone
should know that. But everyone doesn’t know that,” says
Dr. Fischbach. “Especially when you deal with people who have
lots of training in one area or people who are doing family practice,
who have to cover so many areas they couldn’t possibly know
all those things.”
the above points together, and the result sounds like a
personals ad wish list, minus the obligatory “romantic dinners”
comment. Unlike those ads, however, there’s nothing toplofty
in any of these requests. But for every point raised, pathologists
have a response—to which clinicians will often accede.
Dr. Homer, for example, observes there are subspecialists who want
excellent histologic description, then to be left to themselves
to make their own clinical-pathologic diagnosis. These generally
are older, more experienced clinicians, he’s found. “Younger
clinicians who generally have very little, if any, histopathology
training want the whole thing tied up neatly with a bow. They want
a complete clinical-pathologic correlation provided by you—even
though you don’t know the patient,” he says.
Dr. Falk concedes
the point. “A pathologist has the handicap of us not giving
them enough information. That’s a problem, and I don’t
doubt that for one minute.”
strongly promote the pathologist as consultant, including Michael
Laposata, MD, PhD, director of Clinical Laboratories at Massachusetts
General Hospital, and a professor at Harvard Medical School. Dr.
Laposata and colleagues have been developing expert pathology reports,
narrative interpretations that, in simplest terms, focus on two
areas: the differential diagnosis and what clinicians should do
next to make the diagnosis.
that—sensitivity, specificity, pathophysiology—while
important, should be related links on a report, not part of the
actual narrative, he says. “The fundamental piece of information
that these doctors want is, What does my patient have, and what
do I do next?”
the matter of standardization. Consensus criteria make matters much
more clear—but only to those who are aware of and understand
the criteria, says Dr. Homer. “It makes things completely
opaque to the people who don’t,” he says.
Dr. Homer takes
it a step further, noting that some clinicians don’t understand
the fundamental purpose of pathology. He recently worked with a
clinician who was reviewing a lung biopsy with cancer in it from
a patient with a history of colon cancer. The clinician asked Dr.
Homer if he thought the cancer was primary lung or metastatic colon.
Dr. Homer said the histology slightly favored lung and suggested
that additional stains be done. The clinician responded, “Oh,
no, I trust you,” and ended the discussion. “As if this
was something magical, as opposed to actual criteria that get used,”
says Dr. Homer.
he seemed to want is the magical statement from a pathologist about
some unknowable truth, as opposed to a statement of odds,”
he continues. Indeed, he says, he’s encountered more than
his fair share of clinicians who wanted him to say what he felt
about a biopsy. “Which I’ve never understood,”
he says. “Because I don’t feel anything about a biopsy.
I can tell them what’s on it, though.”
All of which
gets back to Dr. Homer’s original point—what clinicians
want depends on the clinician, as well as what the pathologist can
provide. “I encourage pathologists not to say more than they
know,” he says. “I think there’s always the temptation
for the clinician to push the pathologist into the corner, and I
think the pathologist needs to struggle as best he can to get out
of the corner.” This means giving an answer—but not
getting “pinned down to things that are not sayable.”
point, the discussion would seem to have moved to another
stage. It’s no longer a matter of looking for desirable traits
in another. Now it’s time to dig a little deeper and ask,
What do clinicians truly want?
The answer to
that question might sound (warning: semi-sexist metaphor to follow)
like a wife pleading with her husband to please just talk
more. Open up. Share. But, as is so often the case in relationships,
that message gets lost in a maze of other requests that devolve
into inner lives of their own. This explains the befuddled husband
who finds himself huddled with a divorce lawyer, and he thinks it’s
because he didn’t pick up his socks.
has long known of the gap between what clinicians say they want
and what they really want. He also observes that often pathologists
and clinicians aren’t even aware when the wires may be crossed.
Take a high
potassium, a routine test result hardly in need of one of Dr. Laposata’s
expert narrative reports. But a clinician who sees that a patient’s
potassiums have spiked wants to know if the change is “real,”
and not simply the result of a sample being stored for too long.
Most pathologists have the answer to that question, says Dr. Laposata,
but they don’t always convey it. Moreover, he says, pathologists
may need to prompt the clinicians with questions of their own: What
have the potassiums been for the last week? Is there any evidence
of cardiac arrhythmia?
results can be confusing for clinicians, and pathologists usually
don’t understand that clinicians are going to be confused,”
Dr. Laposata says. INR results provide another excellent example.
If a pathologist switches to a more sensitive thromboplastin without
informing clinicians of the new reagent, a PT result can leap from
20 to 40 seconds for the same patient and same blood sample. That’s
an alarm for most physicians, even though the INRs calculated from
the different PTs will be the same. “When they start getting
into the 30-second range for a PT, they get scared,” says
Dr. Laposata. “Communicating to the doctors that this is just
due to the reagent, and to ignore the fact that it’s 20 seconds
longer, has been a major educational problem, and I’m sure
it’s resulted in the infusion of more fresh frozen plasma
into people than they should have had.”
this marriage be saved? A troubled couple might turn to
a marriage counselor. The stand-in here is Seth Powsner, MD, associate
professor of psychiatry and emergency medicine at Yale and, not
coincidentally, the lead author on the aforementioned “Clinicians
Are From Mars ...” article.
says he shared Dr. Costa’s surprise at the error rates they
uncovered in their study. The other surprise, for him, was how physicians
learned to adjust to poorly designed reports. “It’s
like the line from ‘My Fair Lady’—‘I’ve
grown accustomed to her face,’” he says. In the study,
he and Drs. Costa and Homer found that stylistically improving report
formats made matters worse. The reason, says Dr. Powsner, is that
physicians eventually accommodated many of the problems with current
formats. “Physicians have developed visual calluses. They’ve
learned to work a little harder to find that number they need that’s
on the second page.”
Of course, tolerating
problems is hardly a socko point around which to rally. Dr. Powsner
echoes the voices of more enlightened pathologists in calling for
point-blank dialogue with clinicians. For too long, he says, both
sides have relied on formulaic ways of conveying information—the
blood-for-numbers/ tissue-for-histology exchanges that keep true
understanding under wraps.
ease, Dr. Powsner nudges along another approach. “Could it
be that physicians want the answer to a clinical problem, not a
technical question?” Clinicians may ask, What was the patient’s
ALT? How many units of enzyme were measured when we sent you the
serum specimen? “In truth, some of them are sitting back there
saying, ‘I think this patient’s trouble has something
to do with their liver, and I would like to know whether we should
do more testing on the liver. Or, should we move on to some other
part of the digestive tract?’” Dr. Powsner says.
The real answer,
in turn, would be along the lines of: “‘If you’re
worried about the liver, this series of tests doesn’t indicate
that the liver is the primary location for the lesion,’”
he says. “The challenge then for the pathologist is to figure
out a way of offering that kind of information without doing an
individual review of every case and then dictating a paragraph.”
said it would be easy. Indeed, Dr. Laposata’s efforts
to provide those types of answers are coming to fruition after nearly
a decade of work, and he’s the first to admit there’s
plenty of work remaining before all areas of pathology will be covered
by clinically focused expert reports.
On the other
hand, the deeper answers may also be closer, and more simple, than
you think, though you’ll first have to endure another depressing
blow to your oeuvre: In addition to not always understanding your
reports, many physicians don’t even read them, the Yale authors
contend. That means clinicians are often getting critical information
another way. Oftentimes it’s done in a 30-second conversation
in the hallway, or through a quick phone call.
so bad? Maybe not. Though these interchanges are rarely
talked about, Dr. Powsner observes they usually work. “When
the going gets tough, the front-line clinician knows some pathologist
to call, and the action is usually resolved over the phone.”
do get the job done, Dr. Badgett agrees. “We e-mail or telephone
someone like John Olson [MD, PhD, pathologist at UTHSC at San Antonio
and chair of the CAP’s Coagulation Resource Committee]. Which
is probably not the easiest way to get an answer, but it’s
always what happens and what works,” he admits.
might want to keep track of the phone calls they receive from clinicians
asking for clarification, Dr. Powsner says. That, combined with
a satisfaction survey, would yield interesting data. Twenty calls
and high marks from clinicians, for example, would indicate “whatever
you’re doing, they like. But it sure seems to involve the
phone a lot,” he says. “Now, which part isn’t
a one—is suggesting pathology reports are ready for a farewell
tour. Instead, they will evolve, as Dr. Laposata predicts, to a
point where they answer the real questions clinicians are asking
and form the bedrock of better clinician-pathologist relationships.
Dr. Homer puts
a helpful—if somewhat mischievous—spin on matters. Like
many clinicians, he agrees that long—that is to say, three-paragraph—notes
simply won’t get read. Which is why he encourages his pathologist
colleagues to pile on the prose. “Certainly for the complicated
specimen, the long note is better than the short note, largely because
the long notes mean the clinicians will need to call you,”
he says. “Because they’ll read this long note and they’ll
say, ‘Geez, what the hell is that?’”
Karen Titus is CAP TODAY contributing editor and co-managing editor.