Writing the epilogue

September 2005
President’s Desk Column

Mary E. Kass, MD

I have a friend who felt compelled to formulate some parting wisdom before her son left for college. His last weeks at home passed quickly. Busy with the details of departure, they talked about microwaves and laptops, but never the mix of pride and grief that preoccupied her evenings. When it was time to say goodbye, she still wasn’t ready. Standing in the dormitory parking lot, her mind raced, grasping for the right words. Fighting tears, she looked up into the eyes of her beloved firstborn, held him close, and whispered, "Remember to eat your vegetables."

Sometimes you know just what to say and sometimes you don’t. If I had been aware of her dilemma, I might have loaned my friend a copy of the poem that you see at the center of this page. It came to me on a greeting card and I’ve kept it on hand for just such an emergency. This is goodbye and it’s all right there.

Well, almost.

Last month, I promised that this final column would concern our future. My crystal ball is in the shop, so I can’t tell you what the future might hold, but I can tell you a bit about where it resides.

As your president, I have come to know many excellent pathologists, men and women who are fine physicians, excellent scientists, and instinctive mentors. These colleagues are 110 percent engaged in their work. They know how to listen. They take great satisfaction in patient care. When there is a need, they contribute. They expect the best of everyone and they get it. These are the true leaders of our profession, and the arc of their influence will shape our future.

Excellence in our field isn’t about the size of the laboratory or the title on the door. Knowledge and skill are important. Energy and persistence are important. But accessibility is equally important. It is not sufficient to do all things well; our peers and patients must see us, day to day, as physicians engaged in the practice of medicine.

The Laboratory Accreditation Program will soon begin to implement a number of changes that will make our work more transparent to those outside the laboratory. Procedural changes are a good start, but they are only a piece. We must also enlist the support of those who obtain, transport, store, and label specimens. They are important members of our team and we need to bring them on board.

Pathology is a bridge discipline linking the hands-on empiricism that drives direct patient care to the highly technical environment of laboratory medicine. To protect our potential, we must tend to that bridge. This means offering to visit patients to explain test results. It means asking to participate on rounds. It means seeking opportunities to observe surgeries. Senior pathologists may feel awkward at first, asking to follow along on rounds like a resident, but there are worse things than awkward. Irrelevant is one. If we neglect the clinical side, we run that risk.

Continuing patient care experience provides the kind of hands-on learning that our residents need, which is why I would like to see the College promote clinical internships for pathology residents. We need to link the many excellent pathologists in practice today with new physicians who can learn from them. I have been recruiting colleagues to brainstorm about how the College could construct and administer a program to provide one-month clerkships across the country. It’s at the top of my to-do list.

People have asked me whether I have any concerns or worries about our future. There are just two. One is the dearth of women in leadership. The 4,678 women who belong to the CAP represent more than 30 percent of our total membership. Yet, next year, I will be the only woman on the Board of Governors. Women bring an important dimension to the table. Please, if you are a woman, look for opportunities to lead.

My second concern is for those who remain reluctant to step outside the laboratory and engage more fully as members of the medical staff. I fear they may wake up one morning with no place to go. In the end, our future lies in our past; we can learn from history and benefit from experience. The difficulties we have faced as a specialty have occurred when we have presented ourselves as technicians and scientists instead of physicians. We must not lose the passion for telling our story. We can never forget that we are doctors first.

I have appreciated your attention, your support, and your many kindnesses. Now it is time to step back. Never forget that you do what you do because it is what you love. Enjoy your work. Know that your future lies within. Look for opportunities to contribute. And remember to eat your vegetables.