'The Pathologist Role' Questions Flashcards
What is Histopathology?
Histopathology is the diagnosis and study of diseases of the tissues, and involves examining tissues and/or cells under a microscope. Histopathologists are responsible for making tissue diagnoses and helping clinicians manage a patient’s care.
What is the role of the histopathologist in healthcare/patient management?
- Clinical diagnosis - cut ups, specimens, biopsy - grade/stage
- Cancer prevention and early diagnosis - eg screening
- Clinical management - eg efficacy of treatment (chemo/ablation)
- Infection control - eg TB
- Audit
- Research and experimental pathology - eg clinical trials
- Post mortem and cause of death - hospital and HM Coroner
- Teaching
- Community awareness - eg prevalence and prevention
- Disasters/Catastrophes - idenfication of bodies, cause of death, forensics
What attracts you to Histopathology?
Histo related factors:
- Ultimate diagnostic speciality
- Decision making speciality
- Important implications in clinical management
- Covers a wide range of specialities
- Continuously updated
Personal factors:
- Keen attention to details
- Interest in mechanism of disease - have experienced first hand in surgery
- Acts as a bridge between clinical work and research
- Enjoyment of manual dexterity skills
Should pathologists always be doctors?
- Basic medical scientists (BMS) are experienced and educated individuals.
- FRCPath histopathology reporting can be awarded to BMS after certain conditions are met
- BMS can share in surgical specimen cut up, quality control and training (workload management)
- HOWEVER
- Clinicopathological correlation required good knowledge and experience in clinical practice, which is provided by doctors
- With this in mind, histopathologists should be medically qualified
What are the fundamental domains of GMP?
Knowledge skills and performance
- patient 1st concern
- good standard of care
- knowledge up to date
- limits of competence
Safety and equality domain
- prompt action if safety, dignity or comfort compromised
- protect and promote health
Communication partnership and teamwork
- treat as individuals (dignity politeness and right to confidentiality)
- work in partnership with patient (ICE, information given, shared decisions and support to reach that decision)
- work with colleagues in patients best interests
Maintaining trust
- honest & open & integrity
- never discriminate unfairly
- never abuse patients or public’s trust
What GENERAL Good Medical Practice items are applied to histopathologists?
Towards yourself:
- Improve proficiency with CPD, Audit, Teaching and Training
- Protect your health - lab health and safety
- Escalate/seak second opinion appropriately
Towards patients:
- Probity- honest and trustworthy
- Consent
- Confidentiality
- Good communication
Towards Colleagues:
- Work in a team
- Respect
- Share information
- Arrange cover, delegate or refer when indicated
Towards higher authorities:
- Follow regulations
- Know the role of each organisations
What SPECIFIC Good Medical Practice items are applied to Histopathologists?
What makes a good Histopathologist?
Good microscope skills - interpret the relationship between cells and tissues, recognise growth patterns, distinguish lesional and normal tissues
Manual skills - dissect and select representative blocks for processing
Writing/Dictation skills - produce a quality report
Organisational skills - time management, interconnect data, work in a team, refer when needed, know limitiations
Strong clinical background - aware of disease mechanisims, clinicopathological correlation
Decision maker - interpret data, suggest differentials, formulate final diagnosis
Governance - Audit, research, quality control, CPD (continuous professional development)
What makes a good leader?
CPR - CHANGE, PEOPLE, RESULTS
Initiating and implementing change
- Vision of how departments ot teams should develop
- Building relationships within a team
Developing People
- Creates an environment where people can develop
- Ensures good mechanisms in place to resolve conflicts constructively
Delivering Results
- Ability to meet set goals and expectations
- Ability to make decisions that lead to tangible results
- Analyse and solve problems
Key Qualities:
Approachble, assertive, creative, descisive, encouraging, fair, flexible, honest, resilient, supportive, organised
What are the most important skills for working in a team?
Understands their role in the team and how it fits within the whole picture.
Able meet what is expected of them, whilst addressing the needs of the other members of the team.
- Reliable, consistent and motivated
- Approachable and supportive, fair
- Communicates clearly and constructive, listens actively
- Flexible on viewpoints and able to compromise
- Self-aware
- Able to identify problems and draw attention/develop solutions - escalate up
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What teams are pathologists part of?
- MDT
- Laboratory team
- Mortuary team
- Education team - medical students, general public engagement
- Research and audit teams
Only one consultant has turned up for work (there is normal 8). How do you manage this?
1) In house:
- Inform team
- Delegate to senior registrars, with support
- Scientists can perform cut ups, with support
- Reduce some activities - send trainees or utilitise video-conference
- Suspend autopsies
2) Ask for help from local network
- SLA- Service level agreement network hospitals
- Send some work to neighbouring hospitals
3) Hire locum consultants
4) Send work away
- Some companies employ other consultants in other parts of the country
5) Reflect on issues ?another job role needed
- Write job descriptions
- Trust manager support
What are examples of high priority work in pathology?
- Critically ill patients
- Pts who will benefit from early diagnosis - eg biopsy/FNA from clinically suspicious targets (mass, metastases, effusions)
- Post mortems in infective cases, or onse with metabolic/enzymatic changes
- Frozen sections and intra-operative consultation
What are examples of low priority work?
- Screening
- Experimental tests
- Research
- Teaching
- Post Mortems
- Mild inflammatory or cosmetic biopsies
- Elective routine specimens - GB, appendix from child, ectopic pregnancy
What advances are there in histopathology?
Advances in Knowledge:
- Pathological staging updates
- New classifications based on research/molecular and genetic studies
- Research - new grading/prognositic scoring
Advances in Regulations:
- RCPath and College of American pathologists (CAP) continuously update
- Need to be followed by pathologists for consistency of reporting
Advances in Auxillary Techniques:
- Immunohistochemistry staning and digital tech
- Molecular techniques for detection of prognostic markers
Clinical Advances:
- Better targeting of the lesion with less false negatives
- Accurate measurements
- Useful descriptions
What are the current challenges/struggles in histopathology?
- Excess workloads - less consultants/training posts with increased demands on the service
- Clinicopathologic discrepancy - requires more MDT and communications
- Human tissue authority - regulations limit use of tissue retention in research and education
- Changing perception of public - past scandals involving human tissue usage
- Increasing complexity of classifications - further learning, needs CPD
- IT changes - further learning
- Changes in accuracy of other diagnostic techniques - more pressure to correlate with radiological findings eg composite blocks for DCIS
