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The Unseen Pathologist: Why You Might Want To Meet Yours

The right smaller circle is normal breast tissue. The left are the donut-shaped glands, with white centers, that are the telltale signs of an invasive breast cancer. (Image courtesy Michael Misialek)

The smaller circle on the right is normal breast tissue. The bigger circle on the left contains the donut-shaped glands, with white centers, that are the telltale signs of an invasive breast cancer. (Image courtesy Michael Misialek)

By Dr. Michael Misialek
Guest contributor

“How much time do I have?” was the first question Mrs. C asked.

She had called me in a panic. Earlier in the week, I had diagnosed her with breast cancer. She called me after learning the bad news from her radiologist. A whirlwind of appointments with oncology, surgery and radiation oncology ensued, overwhelming her with information.

I knew her case — these cells and her pathology — well, having just presented the pathology at our weekly breast cancer conference.

I struggled to reassure her, telling her that treatment has advanced and catching it early was very encouraging.

But there was silence. I envisioned her on the other end of the line, nervous fingers playing with the phone cord. Finally she said, “It would give me great comfort to meet with you since you are a pathologist. I would like to review my slides along with you.”

Dr. Michael Misialek (Courtesy)

Dr. Michael Misialek (Courtesy)

It was an exceedingly rare request by a patient, but one I deeply welcomed.

I am a pathologist. I spend more time studying your cells and developing a diagnosis then your other doctors spend with you. For particularly tough cases, I ask my partners for help, even send images for another opinion to my academic specialist colleagues, who may in turn show them to still more pathologists.

Many eyes have likely seen your cells. Yet, I am often unseen by you, maybe even unknown. But it doesn’t have to be that way. You can request a meeting with me, you can ask — as Mrs. C did — to review your pathology, whatever the diagnosis, benign or malignant. No request is too small.

Will the health care system allow for this? Won’t it resist? My colleagues from other specialties have embraced it. But currently we cannot bill for these patient consults. That’s part of my reason for writing this: We pathologists are advocating to make our consultations with patients billable, like a patient’s consultations with any other specialists. Pathologists are taking on new roles, and the system needs to change to reflect the value of pathology.
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