College of American Pathologists
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  President's Desk




December 2007
Steps we can take together

Jared N. Schwartz, MD, PhD

You can read Our Iceberg Is Melting, by John Kotter and Holger Rathgeber, in less than an hour, at least the first time. The second time takes a few minutes longer, what with all the underlining.

Iceberg is a deceptively simple story that has the feel of a children's book until you suddenly realize that it's not. The first copy was a gift from my wise and thoughtful partner, Dr. Patrick Wilson. Almost immediately, I ordered 70 copies and had them sent to the CAP Board of Governors, senior staff, and members of committees charged with risk management and strategic planning. It's that good.

Kotter is a Harvard Business School guy with impressive credentials in change management. He and Rathgeber present a case study in team building that introduces a group of Emperor Penguins (dignified, reserved, good-hearted, forever in tuxedoes) living on an iceberg in the Antarctic. As winter approaches, they see signs that their home has been melting from the core. Soon, temperatures will drop and the water trapped within will refreeze and expand. Given the amount of trapped water, the iceberg will most likely explode. If that happens, many will die and the home they knew will no longer exist.

The penguins form a leadership team to deal with the iceberg. The team's first challenge is to overcome predictable resistance to the idea that a problem exists; they do this with science. Resistance persists, but the leaders persevere. The penguins come to understand that they need to think and act like a team, that every penguin has a role.

The penguins were such wonderfully smart, likeable, and stubborn yet caring characters that they reminded me of pathologists. I found myself drawing comparisons.

Their challenges, like ours, were environmental. The penguins were no more a cause of iceberg melting than pathologists are a cause of health-care system dysfunction.

Their solutions, like ours, were not situation-dependent. The penguins, of course, were not limited to one iceberg, and we are not limited to our traditional tools and roles.

The penguins may have looked alike to outsiders, but like any group of pathologists, they were highly diverse. Once they started thinking like a team facing a serious threat, the penguins found that they had members with talents to meet almost every need. Like the penguins, we face gaps in our skill set that need to be filled, but the College team has plenty of bench strength.

They sought advice from non-penguins. When they set out to find a new home, the penguins flagged down a seagull with a totally different view of the world. The seagull provided environmental advice and offered them multiple options. Like the penguins, we can benefit from adopting other points of view.

The penguins set out to find a similar home that was more secure. We build security by expanding on traditional roles. We have the mind-boggling opportunity to practice in an era of incision-free surgery, virtual histology, molecular medicine, and tumor-specific in vivo biomarkers. The value of traditional pathology is not diminished, but it is no longer sufficient. We must explore, build new homes, and upgrade our intellectual equipment now.

This is all part of the new pathology. Pathologists should be directly involved in patient care, evaluating early warning signs and predisposition for disease, taking on active roles in decisions about therapy, and guiding colleagues in the selection of appropriate and useful prognostic indicators. We should be introducing other specialists to the power of biomarkers, gene expression, and pharmacogenomics.

In my hospital, it is almost impossible to turn a corner without bumping into a poster featuring a patient and a caption that underscores the connection between my work and the patient's well-being. It reminds me that everything I do is focused on patient outcome. It nudges me to think ahead.

This is the time of year for thinking ahead, for planning next steps, for setting dates and long-term goals. We need to move from talk to action in expanding our scope of practice. We need to embrace new tools and communicate a shared vision of our collective potential.

People in general do not like change; I guess that's why we have New Year's resolutions. In the box on this page, I have proposed resolutions for the College, steps we can take together to move the profession forward.

If we're going to make resolutions for survival of the specialty, we should not neglect survival of the individuals who make up that specialty. This means mastering new technologies, mentoring younger pathologists, and strengthening ties to other specialists. Many pathologists may feel that they cannot possibly find time to master these new life skills when their workday is already so full.

I think of it this way. Every time we fly, we see a demonstration of emergency landing procedures, including the use of the oxygen mask. The narrative stresses that parents of young children should first get their own masks in place so they can attend to their children.

We have to find time to master new technologies and life skills. They are the oxygen masks that enable us to continue to attend to our patients.

In 2008, let's take care of ourselves.

Dr. Schwartz welcomes communication from CAP members. Write to him at

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