Pathology is at the heart of healthcare systems. However, pathology is a poorly understood medical field by the public and medical community. Time and time again, medical students and doctors who announce they are interested in pursuing or are currently undertaking pathology training are met with the following responses:
“But you’re so good with patients!”
“Why on earth would you want to work with dead bodies?”
“Pathologists? What do they do?”
These familiar and frequent responses often result in pathologists and aspiring pathologists defending their decision by clarifying misconceptions surrounding the field. In some cases, however, these responses can deter medical students from pursuing pathology entirely. This is problematic, as pathology recruitment is already low and declining rapidly. Globally, fewer than 10% of graduating medical students pursue pathology as a future career. Furthermore, between 2010 to 2019, 40.5% fewer senior students from U.S. medical schools opted to pursue pathology training.
Misconceptions about the field of pathology need to be addressed, and the value of pathologists to the community and healthcare field needs to be highlighted.
So, what is pathology exactly?
The Royal College of Pathologists of Australasia website provides a fantastic outline of a pathologist’s role and pathology’s various disciplines. In summary, pathology underpins every aspect of medicine by studying the nature and causes of diseases across the entire human lifespan.
There are many disciplines within pathology dedicated to this role through various methods, including:
- Anatomical Pathology: Looking at tissues from the operating theatre, hospital wards, and post-mortem to diagnose disease
- Chemical Pathology: Looking at the blood for tumor (cancer) markers, hormones, poisons, and therapeutic or illicit drugs
- Forensic Pathology: Investigates sudden or unexpected deaths for medicolegal purposes
- General and Clinical Pathology: Trained across most pathology fields, these pathologists work in country regions and community hospitals
- Genetic Pathology: Analyses human genes for mutations that cause disease to help personalize their medical care
- Haematology: Investigates and treats diseases that affect the blood, such as anemia, blood cancers, and clotting or bleeding disorders
- Immunopathology: Investigates and helps manage blood diseases, including autoimmune diseases and AIDS
- Microbiology: Investigates and helps manage infectious diseases caused by bacteria, viruses, fungi, and parasites
The Value Pathology Contributes to the Community
As you can see, there are many roles a pathologist can pursue, each having a substantial positive influence on the health outcomes of individuals and the wider community across generations.
Informing medical decisions and diagnoses
Danielle Morris, a Flinders University medical student I recently spoke with, framed it as being “the doctors’ doctor.”
Doctors depend on pathologists and the skills, knowledge, and advice pathologists provide. In fact, 70% of medical decisions rely on laboratory test results (pathology); such tests have an integral role in cancer diagnosis. Suppose a doctor has ordered a blood test or a surgeon has removed a lump and wants to understand its nature — a pathologist is usually the one to provide a definite answer.
Improving global health and the economy through preventative and personalized medicine
Thanks to pathology, people can live healthier lives through earlier disease detection. Early detection of diseases such as cancer is greatly enhanced through pathology, which means earlier intervention and a higher chance of successful treatment and recovery. For example, in Australian screening programs, 40% of bowel cancer diagnoses are caught as stage 1 cancers compared to just 14% detected through symptoms alone.
Pathology also helps personalize medical treatments for better health outcomes. For example, the medicine trastuzumab (Herceptin) is more effective on breast cancers that are positive for HER2. Pathology provides the testing for this gene to ensure only patients who may benefit are given this medication and to avoid side effects in those who won’t.
The preventative and personalized medicine enabled by the field of pathology also saves healthcare systems considerable money.
Why Is Pathology Poorly Understood?
The misconceptions about pathology are influenced by many factors. One heavy hitter is a lack of hands-on exposure to pathology in medical schools. Globally, medical schools traditionally teach pathology during the pre-clinical years of medical school (i.e., before medical students enter the hospital environment). Students can opt to undertake a pathology rotation during their clinical years, if available. However, the uptake in pathology rotations is low as students have only been exposed to pathologists as educators rather than clinicians, which devalues pathology’s incentive. It also likely contributes to the devaluation of the pathology field within the medical community over time.
Popular media also contributes to the misrepresentation of pathology. For example, shows like “NCIS” portray pathology as little more than dead bodies, lab coats, and police investigation assistance. While this is a component of pathology, there is so much more to the field, as you now know.
The Final Word
Pathology is at the heart of healthcare systems. It is diverse, exciting, and contributes enormous benefits to health outcomes globally. However, a lack of hands-on exposure for medical students and a media portrayal that only tells part of the story results in myopic insights into this essential field of medicine. People pursuing medicine need to become more aware of pathology and its unparalleled positive health influence on the world. Improving medical students’ hands-on exposure to pathology and a more accurate media representation are just a few ways to make this goal viable.
Harry James Gaffney, MD, is an author, TEDx speaker alumnus, medical researcher, and rural health and pathology advocate who has spoken on several international media platforms.