Choosing Pathology as a Specialty
The Tree of Medicine. Click to enlarge.
J. Carlos Manivel, M.D.
Professor and Head, Anatomic Pathology
maniv001@umn.edu
I am not going to tell you to "do pathology"; and I am not going to tell you that "pathology is the best specialty". You will choose your own specialty and there is no "best specialty" for everyone. In a sense, the best specialty is hopefully the one you choose for yourself; we need good people in all specialties. Besides, there are no "bad specialties"; simply, differences in what interests each of us most. I am going to tell you what we do in pathology and why it might be a good choice for you.
Pathologists are often referred to as "the Doctor's Doctor". Why? When someone has a health problem, he or she goes to see the doctor; and when a doctor has a problem in establishing a diagnosis, he or she goes to the pathologist in search of help. In other words, the pathologist acts as a consultant. The pathologist is an important member of the clinical team; simply put, how the patient will be treated and what the outcome will be depend on the pathologist's diagnosis. As a corollary, the pathologist does not treat patients directly, but deals with other members of the clinical team. This provides interactions that are intellectually very rewarding and a continuous source of learning.
Pathology is the study of disease; as such it has been described as the "trunk of the tree of medicine." It draws knowledge from all basic sciences, which in this allegory would represent the roots, and supports and nourishes all specialties of clinical medicine, that are represented by the branches of the tree. This critical position between the basic and the clinical sciences gives pathology a unique versatility; some pathologists are more basically oriented and are never involved in making diagnoses or in direct patient care; rather, they do research on fundamental aspects of disease. Their research obviously impacts patients, but in a more general sense, rather than specific individuals. On the other hand, other pathologists are exclusively clinically oriented and their work is reflected in guiding individual patients' treatments. Other pathologists, myself included, combine both aspects of our practice and derive material and ideas for research and teaching from clinical practice.
Pathology is divided into two large areas, Laboratory Medicine and Anatomic Pathology. Laboratory Medicine includes all the laboratories such as Blood Chemistry, Microbiology, Molecular Diagnostics, and so on. Anatomic Pathology deals with tissues; the products of our work are diagnoses. While morphology is an important tool in our specialty and it is thrilling to recognize diseases, the microscope is only a tool and pattern recognition is by no means the "end goal" or "objective" of our practice. Its purpose is to provide information that will result in better understanding of diseases and patient care. The material should be used to generate new knowledge through research. The information derived should be used to teach trainees and colleagues and should serve as an opportunity for all of us to learn. It is apparent from these comments that the pathologist has an important mission as a teacher, either in a formal classroom or laboratory setting, or informally, during daily clinical practice.
Since the field of pathology is the study of diseases in all organ systems, there are no limits to the field of our practice. We see diseases from every single organ and system, of every conceivable nature: congenital, acquired, neoplastic, benign, malignant, metabolic, infectious, degenerative, etc. and we interact with every single clinical specialist. The variety and opportunities are simply limitless and make for a very interesting and intellectually rewarding practice. The "revolution in biology" that started a few years ago has resulted in an explosive gain in knowledge; it has been achieved in great part through the study of tissues with techniques of molecular biology. Since pathologists work with tissues, they are in a very strategic and privileged position to generate this knowledge and interact with basic scientists and clinical specialists. In this sense, pathology provides a scientific basis for clinical medicine and a clinical purpose for basic sciences. We are only at the beginning of this revolution in medicine. There is much more to come and the future is very promising. Pathology is a good place to be in, if you want to be an active participant.
We have several elective rotations in Pathology and a Post-Sophomore Fellowship for Medical Students. If you take one of these electives, you will learn hands-on what we do in clinical practice. If you are interested in other specialties, you should make sure that you know the pathology of your specialty and learn how the pathologist can help you treat your patients. If you are curious about pathology, these rotations will provide you with the experience to make a good choice.