MFF0091: Pathology


What is pathology?

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The Medical Fun Facts Podcast is a weekly show with a few facts and hopefully one or two funny lines. Don’t expect too much and everything will be okay.

Last week, in episode 90 I spoke about “O is for Oncology”, I also described Cancer and did a Public Service Announcement on Phallic Health and Hygiene.

Tonight I’m speaking about P is for Pathology.

What is pathology?

Pathology is the heart and soul of medicine. Without pathology, we would not understand, comprehend or appreciate medicine. Pathology is the foundation of medicine, the bedrock on which all medical knowledge is based.

Yes, I’m a Pathologist and a proud Fellow of the Royal College of Pathologists of Australasia.

Pathology is the branch of medicine that involves the study of, diagnosis of and treatment planning for human disease. A medical practitioner who practises pathology is a pathologist and there are many subspecialties. For example, I’m a specialist microbiologist and my role is in the diagnosis and treatment of infectious diseases caused by bacteria, viruses, parasites and fungi. Hæmatologists diagnose diseases of the blood and specifically the cellular components including the precursor cells in the bone marrow while chemical pathologists have a focus on the acellular and intracellular components of our bodies. Most of the work in chemical pathology is concerned with analysing plasma, but chemical pathologists do so much more. Genetic or genomic pathologists diagnose genetic diseases in humans, and different to microbiologists who are also expert in the genetic tools required to identify and characterise many of the pathogenic microorganisms we’re aware of.

Clinical pathologists

The aforementioned subspecialties tend to be clustered into what is known as clinical pathology which I believe is a misnomer. To become a pathologist, you must be a medical practitioner which means years of clinical training, all pathologists are clinicians and practise clinical medicine. Their work involves patients whose lives depend on the work and expertise of pathologists.

Other pathologists

If there are so-called clinical pathologists, what about the others? The three (or four depending on how you count them) subspecialties are probably the better-known ones, at least in the public eye. Anatomical or histopathologists can also be called tissue pathologists because they spend their time cutting up bits and pieces sent from surgeons and other specialists. Check out episode 86 “Be kind to your anus” to learn more about tissue.

The cut up of submitted tissue and organs involves the most exquisite of blades and requires a thorough macroscopic description of the tissue or organ being examined. After the cut up, pieces of tissue are embedded in wax so fine sections can be made in a microtome. The sections are placed onto glass slides, fixed to the glass and then stained using a variety of stains depending on the tissue and what the pathologist is looking for. Hopefully, in difficult cases, the referring doctor has communicated enough clinical information to make the stain selection more appropriate. The pathologist then examines the slides. Coupled with the macroscopic examination and description, the truth is usually revealed by the anatomical pathologist.

Cytopathologists examine cellular material in body fluids or scrapings. For example, cytopathologists review abnormal results from endocervical smears used to diagnose cervical carcinoma, they also look at various fluids for malignant cells, like pleural fluid and urine. The third group of pathologists are the forensic pathologists. While anatomical pathologists will conduct many post-mortem examinations and many anatomical pathologists do so for not only clinical reasons but also forensic reasons, the full-time forensic pathologist is dedicated to ensuring the truth is known for justice and in some jurisdictions, forensic pathologists are employed not by health agencies but by justice agencies. The subspecialty of forensic pathology requires the knowledge of an anatomical pathologist and a whole lot more. That said, the nuances and granularity of histopathological diagnoses aren’t that necessary for much forensic work and collaboration and sharing of knowledge between the two groups often happens. I apologise to colleagues if my descriptions are clumsy. After all, as a microbiologist, I’m sort of an alien chaser. Not only do microbiologists have to understand human medicine but also the biology of bacteria, viruses, fungi and parasites which cause infections.

General pathologists

There is one more major subspecialty of pathology but really, it’s not a subspecialty, the general pathologist is the Jack of all trades and the general pathologist can master one or more of the subspecialties. I know a few and some of them are expert in microbiology because they have taken a special interest but because of where they work they practice in all areas of pathology.

Medical laboratory scientists

While I’m describing pathologists and their work I want to explain the most important people working in medical testing laboratories. The medical laboratory scientists. Medical laboratory scientists can be general and work across all disciplines or they can specialise in particular areas. The output of a medical testing laboratory would not happen without the huge amount of work that medical laboratory scientists put in.

I started my life as a laboratory technical aid, then as a technical assistant and then after completing my bachelor of medical science qualification I worked as a medical laboratory scientist while putting myself through medical school. I love that I’ve worked as both a bench scientist and as a pathologist.

Accreditation

One of the key features of working in pathology which is a little bit different to other branches of medicine is the emphasis on quality management and competence. In most like-minded countries, regulatory authorities, require medical testing laboratories to be compliant with ISO 15189 which is a standard that requires pathologists and medical laboratory scientists to work in an arena of peer review, proficiency testing and quality assurance. Australia led the way in adopting this approach to medical testing by tying this level of accreditation to reimbursement from our national health insurance system.

Some people think that pathologists spend all their time in a laboratory but that’s not true for a significant proportion of pathologists who also have qualifications as consultant physicians. For example, many specialist microbiologists are also infectious diseases physicians, almost all hæmatologists and genetic pathologists are also physicians in the hæmatology and genetic medicine, and there are many chemical pathologists who are practising endocrinology.

A little rant

If you go to one of my websites, viz., drgarylum.com where I used to host this podcast, I make a statement on the front page. If you understand pathology, you understand medicine. Pathologists answer diagnostic questions, they don’t do tests. I also go on a bit of rant about the relationship between referring medical practitioners and pathologists. You don’t order a test, you refer a patient to a pathologist so that diagnostic tests best suited for the patient can be undertaken. It’s a medical relationship. Pathologists are not chefs in a restaurant, we don’t take orders, we participate in the clinical care and wellbeing of patients.

Questions for readers and listeners

Do you know a pathologist?

Would you like to be pathologist?

Who is your favourite TV pathologist? Mine is Quincy, MD who was played by Jack Klugman.

Please leave your answers in the comments section of the show notes or on the Facebook page or on YouTube.

That’s episode 91 in the can.

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Medical Fun Facts is available in Anchor, the Apple Podcasts app, and in Stitcher.

If you have any questions or comments please let me know. If I’ve said anything incorrect I welcome correction.

I’ll catch you next week for episode 92. Something beginning with the letter Q. Send me suggestions.

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Thank you, and good night.

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