College of American Pathologists
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  President’s Desk Column


cap today

The legacy of our calling

September 2003
Paul Raslavicus, MD

This is our legacy, this is our strength, this is our shared obligation, and this is our future…—President James Wright of Dartmouth College, 2003

Suddenly, with the coming of September, it is over. The promise of spring, with the creation of new visions, and the glory of summer, with its abundance of life, are past. Change is in the air.

Suddenly, my term as your president has ended. It seems only yesterday that at my inauguration I spoke with you of my vision for the College and of my hopes for the profession. Barely a month after the tragedy of 9/11 my speech had a patriotic theme, and I urged that we join our hands and our minds as colleagues in a noble calling and create a “pathology nation” based on collegiality, mentoring, and mutual respect. It was a call for a virtual E pluribus unum.

I have written about many issues in this column during these past two years. I wrote of our achievements for the benefit of patients and the health needs of all. I bemoaned the outrages of our tort system that converts medical decisions not to test or not to proceed with surgery into million-dollar mistakes, the horrors of our health care delivery methods that change the primary care physician into an automaton, and the failures of a medical educational system that has succeeded in removing the word “pathology” from the curricula of many of our medical schools. Whether you agreed or disagreed with me, I thank all of you who wrote to me to comment in response.

September signals a change in the College’s elected leadership. President Mary Kass, MD, and president-elect Thomas Sodeman, MD, are in place. I wish them the best.

There is change everywhere, but change in the College, just as in our personal lives, is a continuum. The future is built on the present, just as the present is built on the framework others created. Whatever has been achieved in these past two years rests on the contributions of those who preceded us. Our legacy of dedication to the profession transcends presidents, decades, and even centuries. Our legacy goes back to Virchow and Rokitansky and carries on with Castleman and Sunderman, Stout and Gavan, and Schenken, and all the other giants of our profession who have made their indelible marks.

Long-term commitment to our calling is evident everywhere in our College. Who would have predicted in the early days of SNOP (Standardized Nomenclature of Pathology), created by such visionaries as Roger Coté, MD, and others, that 40 years later it would become accepted as the U.S. and world terminology for encoding all medical information? Under the leadership of president Donald Senhauser, MD, the College reenergized SNOMED with significant capital infusion and created a dynamic pathologist-staff team led by John Neff, MD, and Diane Aschman. Their efforts, and those of our negotiating team, resulted in the agreement with our government that has made SNOMED CT free to all who wish to use it.

In these four decades, the dedication of our “grass roots” to run medical laboratories of excellence, combined with the College’s Laboratory Accreditation Program, has led others to recognize pathology as the key mover in the reduction of patient care errors. Excepting the work of Dr. Codman of Harvard and other such pioneers in the early years of last century, our specialty (and pathologists such as the late William Sunderman Sr., MD, PhD, founding fellow and governor, James Barger, MD, CAP past president, and Bradley Copeland, MD) preceded the rest of medicine by 40 years in recognizing that in order to limit mistakes one must control processes and systems.

In these past two years we have rededicated the College as the premier pathologists’ association that, through education and advocacy, enhances the dignity of our members and the quality of care of our patients. We have created a new and vigorous Education Committee of the Board. The qualifications of our education staff are stronger and our Web-based adult-learning opportunities are beyond anything we imagined only a few years ago. With our emphasis on medical knowledge, systems-based practice, and leadership training, our programs have special appeal to our residents. Our cancer protocols in surgical pathology set the standard for the completeness and interoperability of cancer diagnoses throughout the world. Our first independent annual meeting, forced upon us by circumstances and organized in a limited time, just concluded in San Diego. It was a huge success and brought so many of us together.

Our advocacy efforts are now dedicated to the principles of inclusivity. We have met and will continue to meet with other pathology associations to define our advocacy goals and to ensure that we truly represent all pathology practitioners. Those of you who have specialized knowledge of new technologies and new ways to practice laboratory medicine have been invaluable as we represented to the government the needs of our members.

Our public image has never been better. More and more pathologists are seen as key physicians in the care of patients—not only by the media and the public but also by other medical practitioners. We have reached millions of people through the press and the visual media with our message that the pathologist is a vital component in the care of patients.

We start the future with incredible strength. With a specialty united, with dedicated committee members, with programs and visions that go way beyond everyday existence, your College has achieved preeminence among other organizations. To be as effective as possible, we are committed to reach out to all, whatever their special interests, and join hands to build a unified community of pathologists and medical laboratory professionals. In doing so, we acknowledge and accept the diversity that academia and our subspecialty and special interest organizations and others bring us. We will honor the culture of those who join us. We will be inclusive but never paternalistic.

While we build the College, we rely on the strength of each of you. You are our strength; that is your obligation. You are the intellectual backbone of all of medicine. You are the best of the best. You provide the data and create the information that is the basis of medical knowledge. You are the essence of medicine, and nothing is possible without your work. Therefore, I urge each of you to take up the banner of our legacy and work for the betterment of your specialty and the well-being of those whom we serve.

If you do so, when you shut your office door for the last time, you will know then that you have fulfilled the hopes expressed in these lines by Pulitzer Prize-winning poet Mary Oliver:

When it’s over, I don’t want to wonder if I have made of my life something particular, and real ... I don’t want to end up simply having visited this world.