From speaking with my colleagues, it seems like there is a trend of pathology departments at academic medical centers moving out of the main hospital and into separate buildings. Sometimes their new quarters are a significant distance from the hospital, including the operating rooms. Hospital administrators prefer to use the space for more direct patient services such as additional inpatient beds, and assume that pathologists can do their jobs remotely with the aid of digital imaging, much like radiologists. Some pathologists, especially those who are enthusiastic about digital pathology, embrace this challenge as an opportunity to adopt new technologies. Others are skeptical about whether they can do their jobs as well and as quickly without the physical slides in their hands.
However, the biggest push back seems to be from surgeons. Many of them are uncomfortable knowing that there is no pathologist present on site with whom they can discuss and orient gross specimens or intraoperative findings in person. Different surgeons show varying levels of interest in our work, but there is certainly a significant proportion who seem to worry that the lack of in-person interaction will erode our professional relationship and lead to inferior patient care.
In my experience, surgeons are especially sensitive to the level of confidence that they perceive in pathologists (and in each other). If they sense a lack of confidence, as is often the case with junior pathologists straight out of training, they may ask for second opinions of more senior pathologists whom they know better. I think that part of their discomfort with our being off site is that our interactions with them are as much about the nuances of how we project confidence as about the content of our diagnoses, especially for frozen sections. It will be more difficult for them to “read” us if they don’t know how we interact with people and how we sound when we are confident.
In our eagerness to apply new technologies to our practice and push our field into the future, it is somewhat jarring to realize that many of our colleagues really just want to have us around. Perhaps we should feel honored!
[The picture was borrowed from Vista Window Film Blog.]
3 thoughts on “Does Pathologists’ Physical Presence in the Hospital Matter?”
Isolating doctors from one another is a strong move by administrators in the process of weakening the influence and control doctors have over their profession. Managed care has come a long way in the goal of focusing patient trust on institutions rather than flesh-and-blood doctors. Just as important is the goal of getting doctors to subordinate their practices to institutional priorities rather than professional preferences.
(Separating pathologists from the hospital is good news if one is rooting for the disempowerment of the medical profession.)
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We made the opposite move with some offices right in the OR. The surgeons love it and it definitely makes communication more clear and personal. I think any effort to move pathologists out of the hospital is both short sighted and bad for patient care.
It happens within the UK NHS which is acutely and chronically short of resources. The delivery of services (radiology/pathology) and their impact on clinical management is based on confidence of both those who scan/test to deliver a diagnosis as well as those who act on it. It is essential to establish and share the accuracies of diagnostic procedures, let the clinicians know about it and participate in junior training programs.