How to Become a Qualified Pathologist

Since its establishment as a discipline, pathology has borne an important mission: to assist clinicians in diagnosing diseases. Pathologists rely on observation to discover morphological changes in diseases, so pathological diagnosis is known as the ‘gold standard’ of diagnosis. Faced with the needs of clinicians and patients, we should clearly recognize our own limitations.

Pathology is a bridging discipline that requires a background in basic medical and clinical medical knowledge. One of the tasks of pathology is to provide possible etiological evidence or clues. The diagnosis and differentiation of diseases are inseparable from the observation and description of their microscopic morphological manifestations. Therefore, knowledge of anatomy, histology, and embryology is closely related to clinical pathology work. The continuous enrichment of knowledge in disciplines such as biochemistry, molecular biology, and immunology has brought great help to the genetic diagnosis, personalized treatment, and prognosis assessment of tumors. In practical work, each clinical pathologist has a different disciplinary focus. Joint review of slides by physicians and technicians helps to uncover the deeper meanings of microscopic images, analyzing the occurrence and development of diseases from different perspectives, from morphology to function, from proteins to the molecular level.

Pathology techniques are the foundation of pathology, and the development of pathological diagnostics is inseparable from technological advancement. Why should a pathology diagnostician understand pathology techniques? In practical work, only by participating in technical operations can pathologists truly grasp the principles. Only by knowing the operational steps and principles, and communicating promptly with technicians, can one identify and solve problems in technical operations, enhance camaraderie among colleagues through communication, and promote departmental development. Techniques such as special staining, in situ hybridization, PCR, and gene sequencing hold important positions in the pathology department. Only by knowing their steps and principles can one better conduct scientific research, understand disease mechanisms, and discover reference indicators with diagnostic value.

Specimen sampling is a skill every pathologist must master. Neglecting the description of gross morphology and sampling sites, and focusing only on microscopic tissue morphology, can easily lead to missed or misdiagnosis. For example, in surgically removed thyroid tissue, if a pathologist only focuses on large nodules and ignores small white hard nodules, it may lead to missed diagnosis of micro-papillary carcinoma. Ovarian tumors often contain multiple tumor components; pathologists should observe multiple sections and sample from areas with different colors and textures. Clinical data is crucial for pathological diagnosis of diseases. Taking small round cell tumors as an example, different ages and sites of onset require consideration of different diagnoses.

To seek the truth of disease, to see the big from the small, we must carefully understand the ins and outs of diseases. Treat each pathology request form as if it were each patient, carefully reading and analyzing the information provided by clinicians, and if necessary, going to the ward to inquire about the condition. Before issuing the pathology report, we must carefully verify patient information and other data to avoid unnecessary medical disputes. When issuing, we should comprehensively analyze clinical data, imaging, gross descriptions, microscopic findings, and immunohistochemistry results. After issuing, we should follow up with patients to verify the correctness of the diagnosis, improve doctor-patient relationships, and assist in research. To accumulate and summarize clinical data, we established a patient follow-up registry, conducting regular follow-ups for patients with conditions like lymphoma, summarizing ten years of data to guide further patient treatment and enhance patients’ confidence in treatment.

In addition, we established error/incident registries and feedback books, promptly correcting poor work habits, preventing small issues from escalating, and not letting ‘small sparks start a prairie fire.’

Pathology serves clinical practice, provided that pathologists fully understand clinicians’ needs for case reports and diagnostic work. At the same time, clinicians understanding the process and limitations of pathological examinations facilitates effective communication with patients. Multi-headed microscopes allow clinicians and pathologists to review slides together, enabling comprehensive analysis of clinical data and pathological manifestations, thereby improving the level of pathological diagnosis. As novice young physicians, only by frequently consulting peers can one find the direction for disease diagnosis. Participating in slide reading sessions helps expand diagnostic thinking and stay updated on the latest pathological research progress.

The level of disease diagnosis reflects each physician’s basic ability. Understanding disease mechanisms, finding specific indicators related to diagnosis, and discovering information valuable for prognosis assessment are the work goals of every pathologist. Only through continuous reading of literature and experimental testing can diagnostic and research levels be improved. Additionally, we value teaching work; in the process of teaching and learning, we identify shortcomings in our own work and strive to train ourselves to become excellent pathologists.

● Author: Huang Hui (Department of Pathology, Jiangxi Children’s Hospital, Nanchang)

● Source: Chinese Journal of Pathology–2015, Vol. 44, Issue 2