Helpful Hints for the New-in-Practice Pathologist

 


At the most recent meeting of the CAP's New-In-Practice Committee (NIPC), we discussed initiating an ongoing column about lessons for success. All members of the committee, regardless of the number of years in practice, were asked to relate the practical lessons they’ve learned since graduating from residency.

Stanley J Robboy, MD, FCAP
Stanley J Robboy, MD, FCAP

As a long-in-practice pathologist myself, it seemed fitting that I write the inaugural piece in this series. I originally intended to write something brief. After the initial draft, my daughters, both of whom have long been in practice themselves, said I needed to add some of the lessons I had told them often. While the piece is now longer than originally intended, it’s been approved by two keen students of the workplace.

You will be measured not for falling off a horse, but by how quickly you get back on and ride.

All of us, well, maybe not the luckiest few, will suffer some disappointment during our careers. The disappointments may be minor, such as a missed job, but may be as significant as being asked to leave a position. Sometimes, the disappointment is your own fault, but often it reflects your boss or institution. Examples abound. But people around you will measure you for your integrity—more on that in a bit—and by how quickly you get back on the horse despite all obstacles. Many readers will be surprised by how many of our famous leaders at some time in their career had major falls, only within a short time to go on to new heights. This includes presidents of the United States.

Choose a supportive boss.

Choosing a supportive boss is exceedingly difficult to accomplish. Like a marriage, you may well not know the boss’s nature and eccentricities until a year or longer after taking a position. Also, bosses move and retire, meaning the chances are excellent you will commence with one and change to another in what was otherwise anticipated as stable employment. A thoughtful boss supports and nurtures his subordinates. During the interview, speak with as many members of your future team as possible and, if you’re fortunate (okay, crafty or lucky), with departed members as well.

Feel empowered to take on new assignments, even when painful or a stretch.

Not uncommonly, a boss will ask or even demand that you take on a new area of responsibility (refusing to comply may mean the end of your job, or worse, being labeled as a malcontent). But taking on new responsibilities is an excellent way to win your bosses praise or higher. On my second day in the Army, I received a top-secret memo ordering me as chief of the lab service to prepare a cholinesterase assay. Translated, I was flattered and proud of my clearance, that is, until I read the assignment. The assay was to be used to monitor some 10,000 people in an area where a train loaded with deadly nerve gas would pass. The command was neither a request nor a wish, but an order that assumed any board-certified pathologist was competent to handle. (OH…yes?) Success would undoubtedly go unnoticed, but failure might easily invite court martial. (What a pleasant thought!) Shortly after leaving the Army and assuming my new role as a University junior faculty, my boss asked me if I would like to give the lecture at a major postgraduate course on the subject of intersex, something about which I knew virtually nothing outside of some ill-informed descriptions from Archie Bunker (Intersex was having too much of one, but not enough of the other). I accepted (with abhorrent apprehension), and to my surprise, this became a major area of my research throughout my career.

Be kind to the secretaries and technical staff.

As young staff, you are almost never more important than than the support staff. Likely, you are less important. They can almost always make your life easier, and if upset with you, can easily make your abilities to get things done exceedingly difficult. Oh yes, periodically bring donuts and flowers. Be human.

Be cheerful (ie, not a grouch).

Worry not whether you are an extrovert or an introvert, a badly mangled concept. An extrovert is energized by being in a party with many people. An introvert, if successful, will attend parties, be sociable, and be exhausted when the evening is done. But colleagues and staff always like someone who is cordial with them and with whom they can talk easily.

Avoid staying at work past 7:30 pm.

It is easy to tire, become sloppy, and make mistakes. Many pathologists commonly think it critical to have everything completed before leaving work. Too often, residents tell me they have worked long into the evening—and that means even until 11pm. Here is my alternative approach that I’ve used successfully. If the microscopic slides come out in the afternoon, my approach is to quickly review all cases, spending no more than a few minutes on any single small case. Review, but put aside, the difficult cases. Pick two or three cases that seem particularly difficult or about which you know insufficiently little and read about them at home that night, but only after having a good dinner and spending time with your family. If you get a good night’s sleep and return early the next morning (eg, 6:00 AM), it will surprise you how so many of the difficult cases the night before are now simple and quick to complete. There are always those very difficult cases that you and your colleagues will never get correct, but if you are a resident, your attending will be impressed by how much you do know because you’ve read and thought about the case.

Markets disdain vacuums.

Market vacuums rarely stay empty for long, especially when the abyss can be easily filled. When in any new job, find areas where no one else treads and if the area is of interest to you, and only if it is of interest to you, move into the area and take on the cases. Give conferences on the subject—I began a weekly conference for the Infectious Disease folks on the pathology of their case)—and you’ll be surprised how quickly you become the go-to expert, thus securing your new job.

Help your teammates.

When I was a resident, I offered to do frozen section coverage over the lunch hour and for every non-Jewish holiday. Helping others builds good will. In turn, I was always given time off whenever I needed it.

Treat your colleagues, subordinates, and superiors ethically.

People appreciate this. In the long run, this often comes back in the nicest of ways at the most unexpected times. Ensure everybody’s voice is fully heard, regardless of your thoughts about the other person. Within every organization, there are always persons whose views are different, little use, or sometimes even looney. In committees especially, there’s always the people who like to speak and whose ideas are less than useful or take an overly large amount of time to present. But always be aware. Even for those whom you may not respect, that person may offer that golden nugget that if not considered might sink a promising project. Having considered that nugget may save you from stepping into a pothole and suffering a needless blowup. So listen carefully.

Don’t be greedy.

Generally, everybody feels better, and especially yourself. When beginning projects, share the potential spoils with others. It does not mean to give someone a free ride, but it is helpful to invite others to join, provided that they are willing to fully participate to whatever degree you all feel is important. Manuscript authorship is a prime example. Plan in advance who will be the first and senior authors, especially if there is the potential for multiple manuscripts.

Avoid bragging.

Colleagues like colleagues who are knowledgeable, but not someone who continually harps about how knowledgeable they are. The corollary is never to speak about the way we each did things where we came from. Say that enough times and you might be told you may wish to return there.

Learn how to present uncertainty with authority.

Imagine you are asked for a frozen section consultation and you indecisively say to the surgeon you are unsure what is the lesion (“I missed that day in school”). The surgeon will come quickly to distrust you, and may even suggest you be relieved of duties should that happen with any frequency. Turn uncertainty into something positive. State “This is an exceedingly difficult case and a frozen section diagnosis is fraught with uncertainty. Confidently, assure him he should stop the operation and wait until the permanents are available to have the definitive answer. Much better to have an extra than incorrect operation. Surgeons are comfortable knowing with certainty they should stop. It then is your fault, and not theirs.

Dictate tersely.

There is nothing more boring and a waste of your time than a long-winded rambling dictation. Avoid the travelogue. Too many descriptions start with the outside of the specimen and move inward. By the time the pathologist gets to the key part of the specimen, (s)he is too tired to adequately describe what is present and all too frequently misses describing key elements. I kid you not! Dissect the specimen before dictating a single word, identify the key pathology and sections to be taken before dictating, and dictate in an active tense. Start by identifying the type of specimen received, where the pathology is located with key reference points, and then quickly jump into the pathology. Then describe the remainder. Brevity wins, and, truly, it cuts your work in half.

Unfortunately, I believe almost all textbooks and “how-to-dissect” guides are terribly long-winded and unnecessarily and grievously inflate your work.

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Stanley J. Robboy, MD, FCAP, past-president of the College of American Pathologists, is a professor and vice chairman in the Department of Pathology and a professor in the Department of Obstetrics and Gynecology at Duke University in Durham, North Carolina.