Where Do We Go From Here?

My grandfather, who was self-employed, made a living as a glazier and drove a cab in the winter when he couldn’t hang 10-foot panes of glass 100 stories above the city if it was too windy. The jobs required him to be aware of his surroundings constantly, whether high above the city putting glass on a skyscraper or running the one-way streets around the downtown Loop.

When he would take me to Comiskey Park or Lincoln Park Zoo or years later to Publix grocery store in Florida, my grandfather would walk into a place and say, “Where are we at here?” Of course, he had been to those places dozens of times and knew exactly where he was at. Until his 90s he knew exactly and could still tell you how far the left field fence was or that the tomato sauce was on the left-hand side of aisle 5 as you are facing the back of the store. Similarly, he could tell you every street in Chicago, what direction and for how long it ran. Could likely even tell you who it may have been named for and who he thought the street should have been named for.

Still, when he walked into a grocery store or zoo or we went to the beach, he would stand at its entrance and ask himself, out loud, “Where are we at here?”

I think it is a useful practice. I feel myself do the same thing when I get to the hardware store or pet shop or big box store. Take stock of your surroundings and assess what you need, where you need to go and how you are going to get there. I hear myself ask myself “Should we hit lawn and garden then power tools or power tools then lawn and garden?” There is no one there to answer me, but in terms of making the trip the most efficient and having good cart management I still find this trick I learned from an old glazier and cabbie very useful.

July 1 is a good date to ask one this question. Half way through the year, it is a good time to ask how is the roof holding up, if estimated tax payments are appropriate and on time, for planning for the new school year, football season road trips and perhaps holiday travel. Before you know it, time will be to winterize the lawn mower and de-summerize the snow blower.

July 1 in medicine is also a starting date as well for many – historically medical students become interns, interns become residents, residents become fellows and fellows become attending physicians. Many of us remember our July 1, in a new role with more responsibility and associated stressors.

2020 of course has been a year unlike any our country and the world has ever seen. While the pandemic is nowhere near “over”, the world as we know it has been changed and will continue to change our daily lives and social activities. Where are we in July 2020?

As has been discussed by professional societies and manufacturers alike, remote reads are paramount to the safe, effective and timely practice of pathology and laboratory medicine. While we as a community of medical specialists and vendors have understood this for a long time, regulators now consider the practice, with appropriate validation, a safe and effective means to care for our citizens.

Many of my colleagues in internal medicine, cardiology, gastroenterology and dermatology have shared many successes of telemedicine/telehealth as a safe and effective means to keep people at home and in many cases, out of the emergency room where their exposure could be greater.

In medical school during “History and Physical Exam” you are taught if you listen to the patient long enough they will give you the diagnosis. Somehow this didn’t always work for me as a medical intern, and quickly I fell in the trap of letting patients speak 25 seconds before interrupting them with a barrage of questions hopeful to make a correct diagnosis. However, perhaps with telemedicine we are seeing a back to the future, without the ability to examine, history becomes more critical.

For pathology of course, with the ability to create whole slide images with electronic databases that can be accessed remotely in a secure manner, a global health crisis should not limit our ability to continue to serve our patients.

Clearly there is a new normal here a few months into statewide stay-at-home orders and restrictions on businesses and social events. Clearly, we will all have to learn to work within this environment.

Many folks who work in high rise buildings downtown looking out the windows my grandfather installed tell me they will do so now about 20% of the time as they limit the number of people in the offices and elevators and lobbies in these buildings. Most of time will be remote/work from home.

With an aging population with more chronic diseases and fewer pathologists per capita, the numbers were already tight. For us, the ability to have remote colleagues/consultants, virtual partners if you will, is going to be significant. The alternative, the traditional cardboard flats and microscopes and dictation machines and transcriptionists is not a model for success.

So where are we at here and where do we go from here? The paradigms of hospital-based and/or office-based pathology are changing and the technology can support this. Just as remote cardiology or dermatology is simply cardiology or dermatology, remote pathology will simply be pathology.