Digital Pathology Blog

An old (-er, I mean experienced) pediatric cardiothoracic surgeon once told me, “The heart is not a music box, it is a pump, why should I use a stethoscope to listen to it?” An experienced neurosurgeon once told me, “Neurologists are the tool we used to use before the CT scan” and a critical care intensivist friend has reminded me several times of the value of a stethoscope when you have arterial blood gases, central venous pressure monitoring, and ventilator settings you can adjust for optimum care.  

Some time ago I came across some videos and a TED talk by Dr. Zubin Damania aka ZDoggMD. Born of Indian parents, educated at the finest colleges, medical schools and residencies, he felt his career had hit a wall. He felt he wasn’t making the impact he’d planned to when he first entered the medical field as a physician. So Dr. Damania transformed himself into an entrepreneur, motivational speaker and social media cult figure.

A friend of mine recently put me on to some old, and not so old, articles about radiology services being outsourced, including this story entitled “Who’s Reading Your X-Ray?" in The New York Times, published more than a decade ago, and another article a few years old from NBC News entitiled “Is a doctor reading your X-rays? Maybe not”.

For my nearly 30 years of working in health care - in some form or another – I’ve repeatedly heard one guiding principle: run lean. What does that mean? Lean methodologies have been applied and adapted across just about every type of industry. Banking, construction, health care, government, manufacturing, engineering, design, back office administration and more. It is not just for the more "industrial" sectors; it can and has been applied across a diverse range of industries. There are lean programs for supply chain, administration, management, product development, manufacturing and others.

I arrived for my away rotation early. I was scheduled to be at the Office of The Chief Medical Examiner (OCME) in Baltimore for the month of July. My first rotation of second year of residency would be spent away from the gross bench and chemistry analyzers. The month was actually fine with me – the OCME office handled deaths from all over the state of Maryland including Baltimore city and county, so there would be a mix of the usual inner city homicides, suicides, drug-related deaths, as well as farming, motor vehicle, and boating accidents at the peak of summer in Maryland. And the OCME was walking distance to Oriole Park and Camden Yards and the Orioles were scheduled to play nearly 20 games that month at home. One of the best smelling ball parks in the country would offset the smells of decomposing bodies pulled from the water or burning buildings. 

Pathologists frequently mention “I consulted on this” or “I sent this case off to a consultant” or “We were consulted about…”. But what does it mean? It is frequently puzzling for clinicians or patients. Does that mean my tissue specimen went to another laboratory? Does that mean slides or images from my case were seen outside the institution? Who gets consulted? Who pays for this?

In medical school, the pathologists would come to lecture during second year, and while they had their own subspecialty or research interests, they would often tell us “Pathology is a lot of fun. All of the interesting cases in the hospital wind up under the microscope and you are respected among your peers.”

The Affordable Care Act and market changes like baby boomers entering their senior years with a decreasing amount of doctors to care for them are driving a mind-blowing rate of change in healthcare. Medical practices, including pathology, will sink or swim based on how they adapt to the new realities.

The question sounds cliché. Loosely defined, “team” is a group of people who work together, generally toward shared outcomes or goals. Like many, I grew up playing sports during childhood, we rode bikes without helmets, fended for ourselves, got ourselves to little league games and found out when we got into trouble our parents were generally on the side of the school or the coach. Those days are sadly over but the experiences taught me a couple of key life lessons: