Pathology Department: The Unsung Heroes Upholding the Foundation of Medicine

They handle infectious materials daily, constantly facing the health risks of formaldehyde erosion.

They are not chefs, but their workbench resembles a kitchen stove,with pots, pans, bowls, refrigerators, and ovens all available;

They are not judges, but they make judgments every day,and they cannot allow ‘wrongful, false, or erroneous cases’;

They rarely have direct contact with patients, but through the microscope lens, they can see the life-and-death struggles and the joys and sorrows experienced by patients and their families.

They do not possess the power over life and death, but every result they produce may be a turning point in a patient’s life.

They are known as ‘the doctors’ doctors’ and ‘the judges of life.’

They are the ‘unsung heroes’ hidden behind doctors—pathologists.！

—01

Pathological sections with over 40 processes

For many, this group seems mysterious and unfamiliar. Their working environment is starkly different from the bustling, noisy hospital wards. It is like a ‘pure land,’ with no patients coming and going, no joyful or grieving families, and no mechanical announcement calls—only cold medical instruments, tedious information verification, and the pungent smell of formaldehyde wafting through the air…

Every day, various human tissues removed during surgery are sent here. Lumps from patients’ bodies and tissues from biopsies are placed in transparent specimen bags soaked in formaldehyde. Pathologists work precisely with these ‘chilling’ human tissue specimens. The first task upon receiving a specimen is sampling—selecting diseased tissue from the submitted specimen to create pathological sections. After a night of fixation and dehydration, the diseased tissue is embedded in paraffin the next morning, and pathologists need to cut the tissue into glass sections 4~6 micrometers thick. This process involves over 10 steps and nearly 40 procedures, almost all performed manually by pathologists.

After these tedious and intricate procedures are completed, pathologists can use microscopes and various modern equipment toobserve the tissueto see if lesions have occurred, what type of lesion it is, whether it is inflammation or a tumor, and if it is benign or malignant.

—02

A 30-minute fate diagnosis

A 24-year-old patient had masses discovered in both breasts for four months, and doctors were now making the final judgment. If benign, it would be a cause for celebration; if malignant, it meant this young woman in the prime of her life might lose her breasts.

As usual, the surgeon placed the removed mass into a specimen bag, and the waiting staff quickly placed it into a specimen box, jogging toward the pathology department. The pathology department is located at the southernmost end of the fifth floor of the outpatient building. Compared to the crowded floors below, the fifth floor is unusually quiet. Many patients are unaware that their fate is decided here.

The on-duty pathologist received the delivered specimen, quickly registered and numbered it, then skillfully put on gloves and a mask for sampling. After sampling, the tissue was placed in a -25°C freezing microtome for freezing. Over ten minutes later, a technician cut the frozen specimen into 8-micrometer-thick sections for staining.

The final ‘verdict’It was a breast fibroadenoma, a benign lesion. A cause for celebration.

The patient’s family waiting outside thanked the surgeon repeatedly. They did not know that the preservation of the girl’s breasts was due to the diagnosis made by an unseen pathologist.

—03

It takes 10 years after graduation to stand on one’s own

In the pathology field, there are three ‘threshold fees’: over 10,000 cases to issue preliminary pathology reports; handling 30,000 cases to review reports from junior doctors; and over 50,000 cases to resolve difficult diagnoses. At a rate of 20 sections per day, completing 50,000 cases requires ten years of focused work.The most core and critical step in the pathology department isreading the slides.

It sounds easy, but this step tests the pathologist’s skill honed over ‘ten years of grinding a sword.’ A qualified pathologist generally requires five years of residency training and completion of specified training programs to qualify as a practicing pathologist; from graduation to standing alone, it takes at least ten years. In strict large hospitals, only associate chief physicians or higher are qualified to sign reports. This milestone requires at least 15 years, far longer than the maturation time for doctors in other clinical departments…

—04

Representing the hospital’s diagnostic level

Pathological diagnosis is crucial for clinicians in deciding surgical plans during operations. For example, determining the nature of the lesion—whether it is inflammatory or a tumor, benign or malignant—decides whether to perform radical surgery or local excision; or understanding the infiltration and spread of malignant tumors, such as whether margins are involved, if surrounding tissues are affected, and if there is metastasis in nearby or distant lymph nodes, to determine the scope of surgery.

Today, no matter how precise the examination instruments or advanced the methods, the role of pathologists is irreplaceable. In fact, the level of a hospital’s pathology department represents the overall diagnostic and treatment level of the hospital.

—05

Every pathologist may stand in the dock

Although pathological diagnosis is the gold standard, diseases vary greatly among patients of different ages and genders, and even in different parts of the same patient’s body. Some complex cases may not yield a clear diagnosis at the time.Therefore, from sampling to diagnosis, pathologists proceed with ‘heart-stopping caution,’and the wording in pathology reports becomes increasingly cautious, often using descriptions like ‘highly suspicious,’ ‘could be A or B,’ or ‘cannot exclude C.’

Generally, pathologists go through ‘three stages’: when first issuing reports independently, they are bold; after making several mistakes corrected by senior doctors, they become cautious; and after reading countless slides and gaining enough experience, they become bold again. This起伏 process takes at least ten years, and many who cannot endure it switch careers midway.

—06

‘Gold’ sold at cabbage prices

We know that creating a small section involves multiple processes, each with strict requirements for time, temperature, or reagent concentration, and most are done manually by pathologists.However, pathology fees only include technical costs, with almost no charge for the doctor’s diagnosis. This is unacceptable to many doctors.

For example, a histopathological diagnosis requires pathologists and technicians 3 to 5 working days to complete, but the fee for this service nationwide is generally between a few dozen to 100 yuan. After deducting costs for reagents, consumables, equipment depreciation, etc., there is no room left for labor costs. Such pricing fails to reflect the labor and knowledge value of pathologists.

Unreasonable ‘cabbage prices’ make the pathology department a recognized ‘clean but poor’ office in hospitals,The department’s annual income accounts for less than 1% of the hospital’s total revenue, and typically, pathologists earn only half or even one-third of what surgeons make.and pathologists’ low earnings directly affect medical students’ career choices.

—07

The current state of pathology in China: ‘No one wants to do it, no one knows how, and no students are learning it’

According to statistics, there are only over 9,000 licensed pathologists nationwide. Based on the standard of 1~2 pathologists per 100 hospital beds, the shortage is as high as 40,000 to 90,000. In recent years, experienced and qualified pathology experts are gradually aging and leaving the front lines. Meanwhile, due to heavy workloads, low income and benefits, long training periods, difficulty obtaining research funding, fewer opportunities to publish high-quality academic papers, and low sense of achievement in standing out, clinical medicine graduates show little enthusiasm for pursuing pathology teaching or diagnosis. This leads to a ‘cliff-like’ shortage of pathology teaching faculty and new pathologists. This department, which William Osler, the ‘father of modern medicine,’ called the ‘foundation of medicine,’ faces such a bleak situation in China…

Pathology is the foundation of medicine, and the困境 of pathology is truly the pain of medicine.Establish a reasonable fee mechanism, increase the收费标准 for pathological diagnosis, and respect the labor value of pathologists.Restoring pathology to its rightful place is the future every doctor wants to see.Salute to every pathologist who works默默付出!