Who is a Pathologist?

Pathologists are medical doctors who specialize in the science of pathology, the study of disease. Following college and medical school, pathologists typically spend five or more years to become eligible to sit for certification by the American Board of Pathology in anatomic and clinical pathology. Many pathologists spend additional years of training to receive certification in subspecialty areas of pathology such as dermatopathology (study of diseases of the skin), hematopathology (study of diseases of the blood and bone marrow), immunopathology (study of diseases of the immune system), and cytopathology (study of abnormalities of cells).

Pathologists perform their duties in a variety of settings, including hospital laboratories, free-standing laboratories independent of hospitals, and ambulatory surgery centers. Because patient specimens are easily transported, pathologists working in one of these settings may receive specimens for evaluation and diagnosis from multiple sources such as physician offices, clinics, other laboratories, and hospitals.

What is Anatomic Pathology?

Anatomic pathology involves evaluating tissues (surgical pathology) and cells (cytopathology) through variable magnifications using a microscope.

In surgical pathology, the goal of such microscopic evaluations is to make a definitive diagnosis of a patient's disease. Virtually all tissues removed from patients during surgery (hence the term "surgical" pathology) are examined under the microscope by pathologists in order to determine whether or not a disease is present. Examples of surgical pathology specimens seen by pathologists include breast, prostate, skin, cervical, colon, and bone marrow biopsies. Thus, pathologists play an indispensable role in determining whether a patient's illness is benign, inflammatory or cancerous. The surgical patient's subsequent treatment almost always depends on the diagnosis rendered by the surgical pathologist. For this reason, doctors often refer to pathologists as the "physician's physician," a compliment that acknowledges the fact that the pathologist's diagnosis represents a critical factor in determining a patient's future care.

Cytopathology involves the evaluation of cells under the magnification of a microscope. Pathologists examine cells obtained from body fluids, from solid tissues aspirated through needles and from scrapings of body tissues. The most widely known cytopathology examination is the Pap smear. A Pap smear consists of a scraping of cells taken from the cervix, spread on a slide, stained with a dye to color the cells, and examined by a pathologist using a microscope. Pap smears are considered screening tests, which provide another physician with information that suggests whether or not a potentially dangerous condition is present. If an abnormality is detected, the pathologist may recommend additional diagnostic procedures (such as biopsy of the affected tissue). Other cytopathology examinations may, in and of themselves, be diagnostic of a specific disease condition.

What is Clinical Pathology?

Clinical pathology represents the second major category of pathology. Broadly defined, clinical pathology involves the study of diseases identified by analyzing blood or other body fluids such as urine or spinal fluid (the liquid that surrounds the brain and spinal cord). Frequently, high volume, high technology automated equipment performs these analyses. Pathologists' responsibilities related to automated testing revolve around their roles as medical directors and clinical consultants. Pathologists are legally responsible for the validity and accuracy of clinical laboratory test results and for the function of the clinical laboratory under the federal Clinical Laboratory Improvement Act of 1988 ("CLIA"), for identifying additional diagnostic and/or therapeutic approaches suggested by the laboratory result, and for discussing the possible clinical significance of laboratory results with attending physicians in light of the patient's history and symptoms. In other words, pathologists play a critical role in ensuring that laboratory tests are performed accurately and in a timely fashion. Once again, the pathologist's role as a "physician's physician" makes a critical contribution to the proper diagnosis and efficient management of patients with virtually every disease. Modern healthcare would not be possible without such invaluable supervision of the clinical laboratory.

Why are high quality pathology services important?

To answer this, we must first define quality. Simply put, quality consists of an accurate diagnosis that is communicated promptly to your physician and to you. Accuracy of diagnosis is critical because diagnosis determines treatment and follow-up. Prompt communication of the diagnosis is important to allow treatment to begin as soon as possible, as well as to reduce anxiety on the part of patients who are waiting to learn their diagnosis.

While it sounds like delivering quality should be a simple process, in practice it is quite complicated and involves many people and resources. In order to ensure the highest quality possible, the pathologists at AmeriPath follow a multi-step process:

• A board-certified pathologist diagnoses each anatomic pathology specimen.
• For unusual or difficult specimens, multiple board-certified pathologists often review the case in order to determine the diagnosis.
• When appropriate, AmeriPath utilizes the latest technologies, such as advanced Pap smear tests, special stains, molecular genetics, and flow cytometry, in order to determine the specimen's diagnosis.
• In rare cases, the quality procedures mentioned above may not determine a definitive diagnosis. Those specimens are often sent to a nationally recognized pathology expert in that field to assist with the final diagnosis.

Why is it important for physicians to choose their pathologist?

As you can see from the answers to the prior questions, as the "physician's physician," pathologists work closely with the physicians who are taking care of you. Just as you need to feel comfortable and communicate well with your physician, your physician must feel comfortable and communicate well with the pathologist. The physician-to-pathologist relationship develops optimally when pathologists have worked regularly with physicians over an extended period of time.