The most important thing in communication is hearing what isn't said.
-Peter F. Drucker, 1909
Opportunity and Spirit are twin robots that landed
on Mars in January 2004. Built by the National Aeronautics and Space Administration,
the two exploration rovers photograph, collect, and stream information
about what they find on the surface.
Opportunity and Spirit were named in a NASA-sponsored
student competition. The NASA narratives that trace the rovers' journeys
use nicknames (Beagle Crater, Burns Cliff, Heat Shield Rock) to describe
landmarks; though they're not official, the nicknames seem to personalize
the whole enterprise, bring it closer to home. And there is something
oddly touching about two 5-foot-tall rovers named Opportunity and Spirit
with anticipated life spans of 90 days that are still roaming Mars 31?2
years later, still sending back beautiful pictures. It was evidence gathered
by Opportunity that led scientists to think that conditions on the planetary
surface might once have been capable of sustaining microbial life. All
in all, you can't help but root for them.
The words we use to identify things and people can
create a connection, but we have to be careful about names and words,
because sometimes they can also divide. For example, physicians who specialize
in pathology often refer to physicians in other specialties as "clinicians."
This is a mistake, because when we describe others as clinicians, we become
nonclinicians, which limits our potential and even our scope of practice.
It actually affects how we view ourselves. Clinicians, we know, are physicians
who care for patients. That's us.
Creating distinctions between anatomic and clinical
pathologists is no better. Where would Spirit be without Opportunity?
There is nothing to be gained by putting ourselves in smaller boxes. It
doesn't matter whether we were trained in anatomic or clinical pathology,
or both. We are all physicians who practice one specialty called pathology,
and that specialty needs room to grow. Anatomic and clinical practice
historically were twins with varied orbits, but that is no longer true.
New areas, such as molecular pathology, cross both orbits.
And while I'm on the subject, it's wonderful to enjoy
your pathology subspecialty, but we are all physicians first. In times
of such promise and urgency, the community of pathology must be viewed
as a coherent whole. If the specialty of pathology is to survive, we must
emphasize our commonalities. We need to talk about our profession (medicine)
and our specialty (pathology) in terms of its exciting potential, and
the talk must center on expanded scope and more connection, not greater
I was already preoccupied with some of this when I
left for the International Liaison Committee of Presidents meeting in
Dublin last month. The ILCP provides a forum for the presidents of English-speaking
pathology societies (from Australia, Hong Kong, Ireland, South Africa,
the United Kingdom, the United States, and the World Association of Societies
of Pathology and Laboratory Medicine). The conversation flows easily at
the ILCP meeting; English may be our language but pathology is our dialect
and it is good to spend time together. We practice in different systems
and diverse societies, yet we share the same hopes and concerns.
Several pathology society presidents from countries
with a national health service said that they had already been called
upon to define the value of a physician in directing laboratory services.
The pathologist's added value is the experience and perspective of a physician,
which enables the pathologist to understand the full potential of what
goes on in the laboratory. Only a pathologist, if so focused as a physician,
can fully grasp the therapeutic options and prognostic indicators attendant
to a given test.
Knowing something and sharing what you know are two
separate tasks, and communication between pathologists and other physicians
is a huge concern across the globe. Direct patient care is the mortar
of medicine and its gestalt is an important element of the greater conversation.
There is a growing sense that pathologists would be so much more effective
on the treatment team if our training included more hands-on patient-care
experiences. This feeling is so strong in the United Kingdom that they
are experimenting there with postgraduate clinical rotations in pediatrics,
infectious disease, and hematology.
While lifelong learning in pathology has traditionally
centered on technical skills, new trends in postgraduate education might
point toward bolstering clinical experience. The government may be our
ally in this, because pay for performance may move the reward system in
medicine toward activities that have a direct effect on quality patient
College leaders will continue to look for creative
ways to extend our partnerships within medicine while at the same time
reinforcing our collective identity as pathologists. We have had wonderful
successes already in this regard. The collaboration with the American
Society of Clinical Oncology to write guidelines for HER2 testing is a
great example, and plans to continue this partnership by developing estrogen
receptor-progesterone receptor guidelines is another. Most recently, the
College agreed to take responsibility for a comprehensive textbook of
pathology for eMedicine.com, which is owned by WebMD. The eMedicine knowledge
base already features physician-authored articles on 7,000 diseases and
disorders, and practice guidelines in 59 medical specialties. Thomas M.
Wheeler, MD, who chairs the CAP Council on Scientific Affairs, has agreed
to be editor-in-chief for the project, and our College medical resource
committees are ready to move.
The College is becoming an agent of transformation.
We're reaching out to colleagues in other specialties and taking ownership
of new tools with great promise for improved patient care. We have the
expertise that our patients need and we must find ways to make ourselves—and
our skills—more accessible to them.
Maybe we need to put a name to this initiative, something
that identifies the spirit of the thing. Let's call it Project Opportunity.
Dr. Schwartz welcomes communication from CAP
members. Write to him at email@example.com.