A peek behind the curtain: pathologists are the most important doctors you'll never meet

A peek behind the curtain: pathologists are the most important doctors you'll never meet
Cells go through a staining process. The result can be seen in the logo for my blog. It's always struck me as poignant how beautiful the images are.

An amazing number of people work together to diagnose, treat, and monitor a person with cancer. You’ll never meet most of them: from the lab techs to the engineers who keep the MRIs and CTs and PETs regulated and in good working order, from the radiologists who interpret the results of those scans to the pathologists who are the first to see and interpret the cells that that give you a diagnosis.

From my perspective, pathologists are the most important doctors on your team, and you’ll probably never meet them. These docs see the cells from your biopsy, urinalysis, and blood work and make the call. Do you have cancer? What stage and grade? Everything depends on this initial result. It can be a life changing interpretation.

Unlike your GP, urologist, and oncologist, pathologists are not docs that you choose and you’ll likely never meet them. They are associated with labs and with medical practices. They rarely meet patients or speak to them. In fact, in some areas pathologists are barred from speaking to patients.

But there are exceptions. I’ve had the privilege of meeting Dr. Les Raff, head pathologist at UroPartners LLC. He is a fellow blogger at ChicagoNow and he was generous enough to give me a tour of his facility and talk with me.

I think I took up more than an hour of his time, and it was a dream come true for me to see what goes on behind the scenes. His lab specializes in reading urology slides for a local group of doctors, so he sometimes sees tissue from bladder biopsies, though his overwhelming focus is on prostate biopsies and urinalysis.

As I’ve learned throughout my journey with bladder cancer, there is a good deal of art in the practice of medicine. Dr. Raff explains it this way:

“People think that when I look through the microscope there’s a C on the cells that says it’s cancer and it’s just not that at all and with something like prostate cancer, it’s a very subjective feel….There’s no fence that divides benign from malignant. It’s a continuum and we all fall on different parts of that continuum in our opinions.”

Subjective, perhaps, but not idiosyncratic or impressionistic. Any case that is determined malignant undergoes extensive scrutiny.

Dr. Les Raff, head pathologist at UroPartners LLC

Dr. Les Raff, head pathologist at UroPartners LLC

“Every day our pathologists get together. No case goes out of here with a diagnosis of malignancy that we haven’t reviewed in our daily conference.”

In addition Raff and colleagues keep track of their initial diagnosis. Though his team may interpret the initial biopsy or urinalysis, they do not see the tissue if the prostate or bladder is removed. That tissue is analyzed by hospital-based pathologists.

However, the group follows these results as closely as they can. “We do attempt to obtain the report and compare it to our pre-surgical diagnosis to make sure that there’s correspondence there. Again, if a case is low grade bladder cancer and the cystectomy says its all high grade I’ll go back and look at my slides and ask, 'Why did I think this was low grade?'”

In addition, pathologists work closely with treating physicians. Though patients don’t know their pathologists, their doctors certainly do.

“In our setting, all of the urologists know me, they always know they can get me here. We have the quality meetings that they’re involved in.”

As I’m learning more, I’m understanding the concept of doctors practicing medicine. The good ones are using evidence-based protocols while immersing themselves in the lived experience of their clinical work. They are learning and developing as they see patients and the specimens that represent those patients.

They also learn and grow as human beings. Raff said that when he first began practicing, he didn’t want to interact with patients.

“When i went into pathology I was a young kid and I didn’t want patient contact. Now I’m a little bit more mature and I enjoy discussing and finding out how they’re doing…I’m a part of their medical team.”

Now, however, he not only agrees to speak with patients, but finds it rewarding.

“I enjoy it (meeting patients) in my role as a pathologist…a lot of patients get second opinions. Sometimes they come here to pick up the slides…. when they pick them up they’re standing right outside the door, and we’ll start chatting.”

He stresses that he isn’t a clinician, and he does not offer opinions about treatment. But he does answer questions such as

  • How confident are you about my diagnosis?
  • Are there other tests you can run on my tissue?
  • Is there anything else this could be?

After getting my CT results and the results of my biopsies, I remember looking at the doctors’ names and wondering what they looked like, where they worked, and what their work lives were like. I felt an overwhelming need to meet them and talk with them. I wanted to know the people behind the names.

Dr. Raff has given me the opportunity peek behind the curtain and see the critical work that pathologists do for us.

This is the fourth blog I've written for my coffee shop project. My goal is to explore my community, discover new coffee shops, and blog while I'm doing it. This post required visits to two coffee shops. The first, the Bourgeois Pig, recommended by Ana Martin Segredo, who blogs here.  and the second, The Metropolis in Edgewater, recommended by Howard Moore, who blogs here. The Metropolis is my favorite coffee place so far. Heaven in a huge mug of Americano.

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Filed under: Cancer, Doctors, Uncategorized

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