Screen test: How one pathologist connects with patients
As a recognized specialist in dermatopathology, Paul Shitabata, MD, is accustomed to consulting with physicians around the world. But now Dr. Shitabata is sharing his expertise directly with patients, thanks to the World Wide Web.
A member of the 30-person Affiliated Pathologists Medical Group, Torrance, Calif., the 39-year-old Dr. Shitabata was frustrated about the disconnect he perceived between the pathologist’s expertise and the patients who benefit from it.
"It was clear to me that no one really knew what a pathologist did," he says. "There are so many medical decisions important to the patient that are made by the pathologist, but the patient has no idea. Even my mother wonders sometimes."
Surprisingly, a worker in the accessioning department at Dr. Shitabata’s medical group, which services 10 hospitals and two reference labs in Southern California, once asked him what he did. "Pathologists are so underrecognized," he groans.
An exchange with a knowledgeable patient triggered the thinking that led to the Web site. In late 1998, a man came in with the X-rays and report of his wife’s biopsy for breast cancer. "He insisted on talking to me about the case," Dr. Shitabata recalls. "I asked him why, and he told me, ’You’re the pathologist who makes the diagnosis. You’re the most important person to talk to.’"
Dr. Shitabata wanted a place where all patients could, in effect, talk to him, so he created a Web site devoted to explaining the pathologist’s view of medicine. Enlisting the Internet expertise of a colleague at his medical group, Eric F. Glassy, MD, Dr. Shitabata used his own database of information to create a site he calls "The Doctor’s Doctor" (www.thedoctorsdoctor.com), which focuses on surgical pathology.
The site is aimed at patients. A message on the home page reads:
This Internet site is designed to help you get information about laboratory tests and diagnoses. We want you to be an informed patient who understands all aspects of a disease diagnosis. Pathologists-’the Doctor’s Doctor’-oversee many of these results and can be a vital member of your health care team.
To that end, the site offers two primary types of information: explanations of who pathologists are and what they do, and reports on diseases-how they’re diagnosed, and what new developments are occurring.
For example, a presentation on melanoma discusses whether the incidence of this cancer is reaching epidemic proportions, as some lay articles have suggested. (The increased incidence is real, Dr. Shitabata says, but there’s no epidemic.)
The Web site, which has been live since 1999, is set up to help patients understand their pathologist’s report. For instance, the section on the Pap test explains the history of the test, what it’s used for, and how the sample is obtained, and it defines terms such as ASCUS, LSIL, and CIN. The site also says that patients can fax a laboratory report to Dr. Shitabata, who will "translate" it for $50 per report. The translation is sent to the patient and his or her physician.
The Web contains scant information devoted to the pathologist’s view of medicine, Dr. Shitabata says. "You can’t do a Medline search and find pathology terms unless you know exactly what you’re looking for." In today’s medical environment, he adds, clinicians spend less time with patients and often don’t have time to explain the pathologist’s report.
Dr. Shitabata believes that his site, which is readily available to all comers (there is no password protection or subscription fee), can help pathologists take more of a consultant role in patient care. "I’m not saying we should make house calls," he says, "but it is vital that the patient understand our role."
Dr. Shitabata enhanced the site with information that appeals to physicians, including a database of abstracts offering the latest information on numerous diseases. Dr. Shitabata began offering the abstracts after getting a feel for who was using his Web site. "It was obvious that some of them are extremely sophisticated," he says. "They would e-mail me questions of the type that I would discuss with other physicians." (The Web site displays his e-mail address, firstname.lastname@example.org, on every page.)
Dr. Shitabata eventually added even more abstracts under the heading "Diseases and Medical Information" and a section called "News You Can Use." Rather than link to the entire article, which is often not displayed online anyway, Dr. Shitabata simply cuts and pastes available abstracts into appropriate spots. As an example, the section on Pap tests contains recent abstracts on ASCUS and LSIL from the American Journal of Clinical Pathology.
On the surface, the site is tailored to patients, but clinicians who dig deeper will find the trove of abstracts. "This should be a very good reference for physicians and pathologists," Dr. Shitabata says. "The majority of the abstracts are from the pathology literature, setting it apart from other medical information Web sites." He adds that physicians impressed with the site’s uniqueness have e-mailed their comments and requests to him.
No advertising is allowed on the site, though vendors have asked for the opportunity. The site gets 3,500 to 5,000 hits and about 350 unique visitors a day. "That’s respectable considering we don’t do any advertising. It’s mainly word of mouth," Dr. Shitabata says, but "there is also a link to the site placed on our billing reports to patients." Because most of the expertise was available in-house, setting up the Web site was inexpensive. Drs. Glassy and Shitabata used the Dreamweaver and Fireworks programs from Macromedia, which cost about $400 total, to build and maintain the site.
Dr. Shitabata spends five to six hours per week updating the site. "My goal is to add a new disease a day," he says. His database now numbers in the hundreds of diseases, including rare conditions such as Rosai-Dorfman, and contains selected pathology images. Dr. Shitabata responds to e-mails daily from patients and doctors, but he believes that most of those e-mails substitute for phone calls.
"This is a labor of love," he says, because, except for the $50 translating fees, no compensation is involved. And the income from that is minor—he’s had only a few requests so far. Then there’s the added cost of an Internet liability policy, which the medical group had to obtain to offer online advice. Dr. Shitabata plans to add a second moneymaking service soon, aimed at providing second opinions to patients who request them and whose insurance covers that service. "We’ll just bill the insurance carrier," he says.
Dr. Shitabata has had to limit how much he does with the site, which could easily consume all his time. "I get constant e-mails from doctors suggesting additional references," he says. He’s also been judged for not supplying enough detail or overlooking important articles.
"I’m aware that people will raise issues over why I include some articles and not others," he says. But the Web site doesn’t aim to be all-inclusive. Rather, it is Dr. Shitabata’s personal vision "of what I’ve found useful as a pathologist and what has been helpful to my patients."
Karen Southwick is a writer in San Francisco.