Your Doctor, the Pathologist, Will See You Now

Like most medical trainees, I entered medical school assuming that meeting with and caring for patients directly would be an important part of my career. I learned to take detailed clinical histories, to perform comprehensive physical examinations, to order laboratory tests, and to diagnose and treat diseases, cultivating a sense of personal connection to my patients and their journeys to wellness that I enjoyed deeply. Little did I know that in my later years of training, I would fall in love with the microscope and the detective work that led to truly having the power to solve medical mysteries. In choosing to be a pathologist, I also chose to become detached from the patient-facing elements of the traditional physician archetype—or so I thought.

In this issue of the journal, Lapedis et al¹ present a qualitative study of pathologist attitudes toward patient-facing pathology practices, a set of new initiatives of which I am a vocal proponent and practitioner. The article summarizes a survey that was administered via Twitter (San Francisco, CA) to a group of pathologists over a 3-week period in early 2019. More than 85% of the 197 pathologists who responded to the survey expressed a strong interest in meeting with patients regardless of age, sex, or rank factors. This study demonstrates that, like me, many pathologists believe patient interaction to be an important part of their professional goals. Such data suggest that developing and prioritizing patient-facing practices should become an important option for all pathologists to consider as they move through their careers.

In interpreting the potential impact of this study, we must consider if the desire for patient interaction is one-sided on the part of pathologists. Anecdotal evidence shows us that pathologists are already meeting with patients through established programs referred to as pathology education clinics and patient-centered pathology or patient pathology consult clinics. Recent studies of these initiatives demonstrate the clear desire of patients, particularly those with cancer diagnoses, to gain more knowledge about their disease directly from pathologists.^2-4 In my personal experience of meeting with over 125 patients in the past 3 years in our well-established patient pathology consult clinic at Lowell General Hospital, I have been deeply moved by the immense gratitude expressed by each patient and their family for the opportunity to review their biopsy specimen with a pathologist from our team. These face-to-face interactions ensure that nothing gets lost in translation as the patient aims to understand the full scope of their disease. I believe that as pathologists, we too can be visible members of a patient’s care team, and as this study indicates, many pathology colleagues agree.

Another important consideration in evaluating the impact of this study is the logistical feasibility of patient-facing practices in pathology. The foundational steps in establishing such practices have been well documented in the article from Booth et al² and include (1) gaining the trust of the referring clinical team and (2) demonstrating value, primarily through patient feedback to the referring clinician and hospital administration. Appropriate discussions with risk management, professional liability, and hospital leadership teams are also necessary in implementing these practices. In addition, a feedback tool with survey responses from the patients is one way to optimize the program in its early stages, as valuable guidance from the patient helps to make operational and logistical changes to the program. From a value on investment perspective, our pathology clinic at Lowell General Hospital has clearly demonstrated that reimbursement by insurance companies is achievable if the appropriate documentation is provided. Personally, I disclose the out-of-pocket charges to the patient at the end of my clinic to relieve any fee-related anxiety. I also provide them my direct contact information if they want any further clarifications about their illness, which in my experience patients have been extremely respectful in using. Now that this study by Lapedis et al¹ has shown us the desire for patient-facing practices among pathologists, it will be important to disseminate the logistical information discussed above to ensure success for those physicians eager to explore these options.

Why is now the right time for the emergence of such practices in pathology? I believe that considering increased access to the Internet, digital pathology, personalized medicine, and telemedicine visits, as well as the challenges and opportunities emanating from the coronavirus disease 2019 pandemic, pathologists are particularly well positioned to embrace patient-facing practices. Moreover, with deployment of physician extenders providing care, patients are seeking resources that provide accurate and comprehensive information about their illnesses. As 70% or more of objective data regarding a patient are generated in a laboratory, the pathologist is poised to fill that role of interpreter for the patient to better understand their health, performing a key role in apomediation² for the health care consumer. In addition, access to patient portals heralded by the 21st century Cures Act will create additional opportunities where a patient and pathologist can finally meet as the patients access their pathology reports online. They will see the pathologists’ names on the reports and seek them out if they need more information. As quality measures and patient satisfaction metrics are becoming mainstream in medical care, allowing access in creative ways to provide comprehensive and holistic care to the patient is vital. With many stars rightly aligned at this moment in time, I hope many pathologists will act upon their desires for patient interaction and embrace unique opportunities to truly become visible to their patients.

I believe that this increased visibility not only will have positive effects for patients and pathologists but also serves a future-oriented purpose in helping to recruit many talented young physicians to the field of pathology. As more and more basic science content in medical schools is taught in an integrated format, medical students are often left without a clear picture of how pathologists bring value to the patient’s care. With as few as 2% of US medical graduates choosing to enter the field of pathology, increased visibility of patient-facing pathology practices will show these graduates that patient interaction and a career in pathology are not mutually exclusive. As pathologists, I believe we can reject the notion that our discipline is inherently isolated from patients and educate our colleagues across specialties of the important role we can provide to the patient.

I do acknowledge that this is not a traditional role that pathologists have embraced in the past, and it may seem overwhelming and intimidating for someone who was not considering this role when they chose this career path. We must remember that all of us have the roots for patient interactions well established during our medical school training and that doctors in other specialties receive postgraduate training to hone their patient communication skills. But for the 15% or so of pathologists who chose to not pursue this role, the article clearly states the concerns, including “mixed messages,” that can be confusing to the patient.

Ultimately, I want to underscore the personal impact that patient-facing practice has had for me as a pathologist. Meeting the patients and being inspired by their courage has certainly affected my professional journey. It has helped me find meaning for and impact of what I do every day. Other pathologists have shared similar experiences.³ As Jug et al³ and Lapedis et al¹ state, exploring such interactions in reducing burnout is an area that needs further investigation.

It is fulfilling and rewarding in many ways to be available to the most important person that we serve every single day each time we peer through the microscope. The patient can finally meet the one invisible person in his or her care team who actually spends countless hours searching for the right diagnosis and optimizing and researching the right treatment strategy. I hope that patient-facing pathology practices will become mainstream in the next decade, improving outcomes for both the patient and the pathologist.

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