Volume 197 - Issue 11
50 shades of blue and pink: the 10 cardinal sins of the clinician . . . according to his anatomical pathologist
Authors: Admire Matsika and Bhuvana Srinivasan
Med J Aust 2012; 197 (11): 668-669. || doi: 10.5694/mja12.11437
Published online: 10 December 2012
Published online: 10 December 2012
In an “informal survey”, anatomical pathologists spill their guts on what irks them most in their day-to-day interactions with clinical colleagues.
Some studies have shown that there is a serious communication gap between clinicians and pathologists.1 “Clinicians are from Mars and pathologists are from Venus” has been the impression of some authors.2 Others have aptly described the clinician–pathologist relationship as “peculiar yet the two are not dissociable”.3 We view the relationship as similar to that of two separated, doting parents sharing a noble goal of raising their children. While both sides have good intentions, misunderstandings and assumptions that can adversely affect their progeny may occur. To achieve excellent patient outcomes it is imperative that clinicians and pathologists understand each other and learn to work harmoniously.
A survey by way of informal conversations was carried out among anatomical pathologists in Queensland to determine what irked them the most in their day-to-day interactions with clinical colleagues, and we collated the results.
Among the many sins that are committed by clinicians, 10 stand-outs give most anatomical pathologists a twitching palm. As our survey has shown that male clinicians are more likely to commit these sins than their female counterparts, we will refer to our fictional, rogue clinician as the masculine Dr Grey.
His clinical history
As pathologists, we work on the dictum that Dr Grey is always wrong until we prove him right. He is so cool that he does not write any clinical history on the request form. Rarely do we find Dr Grey’s clinical history elaborated beyond, “skin”, or “histo”, even though we have tried to convince him that providing us with his clinico-radiological impression is not cheating and will not compromise our diagnosis. Submission of a tissue specimen to the pathology laboratory is a specialist consultation, and mentioning just the tissue organ on a request form is as helpful as stating only “brain” on a referral letter to a neurologist. Dr Grey’s clinical impression is the equivalent of history-taking in histopathology. In 2013, when Dr Grey sends us a specimen with the request “skin, histo”, pathologists have unanimously agreed to issue the histology report as follows: “Skin histology confirmed.”
His poor penmanship
Dr Grey’s written requests are appallingly cacographic. Once, when asked to explain what he had just written, he could not read it himself. Lay family and friends often comment, in jest, how medical practitioners must be taught cramped handwriting at medical school. We all splash it on every form we fill out as if it is our badge of honour; but Dr Grey’s request forms are so bad they appear to have been marked by a chook scratching around for worms. We recommend he delegates the writing to his theatre staff, or just ticks the boxes on electronic request forms.
His “urgent” problem
Dr Grey’s laboratory requests are sometimes unnecessarily marked as urgent. A longstanding skin carcinoma on an elderly patient is surely not urgent — even if the patient is the practice’s favourite, is anxious and going on a cruise that day. When the majority of cases received in the laboratory are inappropriately flagged as such, it follows that the genuinely urgent cases requiring expedited handling are going to be seriously compromised.
His need for immediate gratification
We have come to realise that sometimes Dr Grey orders frozen sections out of curiosity, when it is not going to change the immediate, intraoperative decision. Once we received a frozen section request for “? Intra-abdominal malignancy”. The theatre room was rung 10 minutes later with the diagnosis, only to be informed by theatre staff that Dr Grey had already closed the abdomen and was now in the tearoom reading the morning paper! We are, however, impressed by his speed at performing complex surgery.
His preposterous use of non-medical terminology
On the rare occasion when Dr Grey volunteers a clinical history, it reads: “blood in urine “, or “pain in the back passage”. It is confirmed that Dr Grey is extremely smart. In fact, we and Dr Grey were on top of our class at medical school. We therefore cannot fathom why he does not use the unequivocal and admissible medical terminology for such symptoms — in this case, “haematuria” and “proctalgia”, respectively. Sometimes we cannot help but feel patronised by such condescending cordiality from a learned colleague.
His demeanor at clinicopathological meetings
Although we are regularly invited to present interesting cases at the multidisciplinary meetings (MDMs), we are of the opinion that Dr Grey is not particularly interested in our histopathology slides. We have come to believe that at these events our colourful images are decorative and our diagnoses are of less importance than the management discussions that ensue. Dear Dr Grey, when we come to the MDMs we are genuinely excited about our morphological findings and are delighted to share these with you. This includes showing you the fiftieth shade of blue and pink that separates this tumour from the other 49 differentials in the textbook!
His withholding of refreshments
Because we only handle non-salvageable tissue and non-medicating, deceased clients, we are invisible to the drug representatives who visit the hospital weekly with a bunch of goodies. Dr Grey, however, has the charisma that keeps them returning, and we believe it is his duty to arrange sponsorship for the meetings and feed us as his invited guests. An MDM without nibbles is as perplexing and unsatisfactory to us as an unconsummated marriage. Henceforth, it will be the pathologists’ prerogative to decline MDM requests where refreshments are not served to their specifications and tastes.
His impatience
Dr Grey is so ahead of time that he often rings us enquiring about a histology result just as the specimen arrives. While his enthusiasm and efficiency is to be applauded, the processing time for some specimens is protracted. Large specimens, bone and fatty tissue require several hours of fixation and processing for optimal results, particularly where ancillary studies are indicated.4 Until such time as our long-awaited laboratory time machine is installed and running, such sophomoric requests from Dr Grey will be politely ignored.
His indecisiveness
Dr Grey habitually adds further cases for discussion to the MDM agenda only a few hours before the meeting commences. The brilliant anatomical pathologist is naturally a perfectionist, always striving to deliver a polished piece of science and art with each case that he or she signs out. When Dr Grey submits a specimen in the morning and then requests the case to be added to the lunchtime meeting, we remind him that, while we are accommodating and understanding, we do not operate at the speed of light and cannot condone such unpreparedness.
His use of acronyms
The junior clinicians in Dr Grey’s team are so creative that we sometimes have to go to great lengths to decipher the acronyms they use. Recently, a soon-to-be-retiring senior pathologist sought our opinion on an esoteric clinical history that read: “P0G1, EMLSCS for RIF, TPL @ 12/40; FD @ K36+4 g?T21”. Decoded by us on his behalf, this meant that this was a placenta from a first pregnancy, sent after an emergency caesarean section at 36 weeks’ gestation for right iliac fossa pain and fetal distress in labour; the neonate had physical anomalies, yet to be diagnosed, that raised the clinical impression of Down syndrome; there had been an episode of threatened abortion at 12 weeks. When he sighed and exclaimed, “WTF!”, we realised it was just an OMG moment for our seasoned MVP as he acquainted himself with 21st century medical lingo, and we all LOLed!5
Competing interests
Admire Matsika is male, married to a clinician. Bhuvana Srinivasan is not at all conflicted but has agreed to seek help for her quirky sense of humour.
Acknowledgements
On his behalf, we acknowledge the efforts of Dr Grey’s long-suffering wife, nursing and secretarial staff in keeping him on the straight and narrow.
References
- Farias-Eisner R, Shapter A, Fu YS. The importance of communication between the pathologist and the clinician in caring for patients receiving gynecologic treatment. Am J Clin Pathol 1995; 103 (4 Suppl 1): S13-S16. 0_CHDEGJHI
- Powsner SM, Costa J, Homer RJ. Clinicians are from Mars and pathologists are from Venus. Arch Pathol Lab Med 2000; 124: 1040-1046. 0_CIGJIEFA
- Tranbaloc P. [The clinician and the pathologist: a peculiar, yet not dissociable couple] [French]. Gynecol Obstet Fertil 2005; 33: 961-963. 0_i1115621
- Matsuda Y, Fujii T, Suzuki T, et al. Comparison of fixation methods for preservation of morphology, RNAs, and proteins from paraffin-embedded human cancer cell-implanted mouse models. J Histochem Cytochem 2011; 59: 68-75. 0_i1115623
- Urban Dictionary. [Refer to entry for each abbreviation.] http://www.urbandictionary.com (accessed Sep 2012).