Choosing Pathology as a Specialty
J. Carlos Manivel, M.D.
We all chose medicine for a variety of reasons among which, there is invariably one: we want to know what is wrong when something is not working well in the human body. Ideally, once we know what the problem is and how it operates, it can be fixed or yet even better, prevented.
Simply defined, pathology is the study of disease; therefore, anybody who chose medicine, must by definition love pathology; being in medicine and not loving pathology is an oxymoron. Then, what is the difference between "Pathology" as a body of knowledge and "Pathology" as a specialty? Pathologists use that body of knowledge supported by a variety of techniques such as microscopy, molecular biology, biochemical essays, etc, to establish diagnoses.
Pathology has been described as the "Trunk of the Tree of Medicine" (See figure). It draws knowledge from all basic sciences, which in this allegory would represent the roots, and supports and nourishes all specialties of clinical medicine that are represented by the branches of the tree. Simply put, pathology provides the scientific basis for clinical medicine and a clinical purpose for basic sciences. Its critical position between basic and clinical sciences gives pathology unique versatility; some pathologists are more basically oriented and do research on fundamental aspects of disease. Their research obviously impacts patients, but in a more general sense, rather than as applied to specific cases. On the other hand, other pathologists are exclusively clinically oriented and their work is reflected in guiding individual patients' treatments. Academic pathologists combine both aspects of the practice and derive material and ideas for research and teaching from their clinical practice.
The specialty of pathology is divided into two large areas, Laboratory Medicine and Anatomic Pathology. The former includes all the laboratories such as Blood Chemistry, Microbiology, Molecular Diagnostics, Transfusion Medicine, Cytogenetics, and so on. Anatomic Pathology deals with tissues; including biopsies, cytology and autopsies. The product of pathologists' work is information—diagnoses—that will help guide treatment and establish prognosis. While morphology is an important tool in our specialty and it is thrilling to recognize diseases—and critical for patient care—the microscope is only a tool and pattern recognition is by no means the "end goal" or only "objective" of our practice. Its purpose is to provide information that will result in better understanding of diseases and patient care. Every single case is an opportunity to learn and to teach.
Since pathology is the study of diseases from all organ systems, there are no limits to the field of our practice. We see diseases from every single organ and system, of every conceivable nature: congenital, acquired, neoplastic, benign, malignant, metabolic, infectious, degenerative, etc. and we interact with every single clinical specialist. The variety and opportunities are simply limitless and make for a very interesting and intellectually challenging and rewarding practice. The "revolution in biology" that started a few years ago has resulted in an explosive gain in knowledge; it has been achieved in great part through the study of tissues with techniques of molecular biology. Since pathologists work with tissues, they are in a very strategic and privileged position to generate this knowledge and interact with basic scientists and clinical specialists. We are only at the beginning of this exciting revolution in medicine. There is much more to come and the future is very promising. Pathology is a good place to be in, if you want to be an active participant.
Pathologists are often referred to as "the Doctor's Doctor". Why? When someone has a health problem, he or she goes to see a doctor; and when the doctor has a problem in establishing a diagnosis, he or she goes to the pathologist in search of help. In other words, the pathologist acts as a consultant. The pathologist is an important member of the clinical team; simply put, how the patient will be treated and what the outcome will be depend on the pathologist's diagnosis. As a corollary, the pathologist does not treat patients directly, but deals with other members of the clinical team. This provides interactions that are intellectually very rewarding and a continuous source of learning.
Electives: We have three, four and six week elective rotations for medical students in Anatomic Pathology. If you take one of these electives, you will get first-hand exposure to what we do in clinical practice. If you are interested in other specialty, your goals for this rotation should be to become familiar with the pathology of your specialty and to know how the pathologist can help you treat your patients. If you are curious about becoming a pathologist, these rotations will provide you with the necessary experience to make a good choice. I am not going to recommend you to "do pathology"; and I am not going to tell you that "pathology is the best specialty". You will choose your own specialty and there is no "best specialty" for everyone. Without a doubt, the best specialty for you is simply the one that best fits your aspirations; we need good people in all disciplines.
Whether you have chosen to become a pathologist, or are considering this possibility, you should give yourself an opportunity to learn why we are so excited about our specialty!