March 2010
Feature Story

Anne Ford

The letter he received was brief, and its phrasing was quirky—but former CAP president William Zeiler, MD, had no trouble understanding it. Having endowed the Mayo Clinic’s Geraldine Colby Zeiler Professorship of Cytopathology in 1992 in honor of his late wife, he knew that each year Mayo used part of the funds he’d donated to host physicians from around the world on month-long pulmonary pathology and cytopathology scholarships. He just hadn’t known how much his gift could mean to a young pathologist. Then one wrote to tell him.

“Dear Professor Zeiler,” the letter read. “I am Shirin Karimi, assistant professor in Shahid Beheshti UMS [University of Medical Science], Tehran, Iran, an Iranian pulmonary pathologist who got your scholarship from Mayo Clinic... Now I know how to approach my problem cases and take part in our tumor boards more actively. I have got enough confidence (because I went to Mayo Clinic!) to make diagnostic and even therapeutic decisions for my cases in our center... All of these are because of your donation and humanity and also all of the pulmonary pathologists in Mayo Clinic with great scientific morals. In this atmosphere, I believe all of you have become immortal. On behalf of my patients, I would like to say: God bless you and thank you very much.”

For Dr. Zeiler, this letter and others like it have driven home just how far the effects of a gift like his could reach. “The good that’s come of this is absolutely so widespread,” Dr. Zeiler says. “A tremendous amount of work has been done.” His gift has sponsored training for at least 20 young pathologists from the United States and abroad; it has also funded many lectures and papers and “helped accelerate the development of an anthrax detection method following 9/11,” says Thomas V. Colby, MD, current holder of the professorship (and no relation to Geraldine Colby Zeiler). “I think we’re doing an amazing thing with these funds.”

Dr. Zeiler’s gift is just one example of the power of one pathologist to advance the profession by endowing a professorship, whether at his or her alma mater or at another institution with personal or professional significance. “If you put money in the hands of an institution with some vision, something special will happen,” says Michael Laposata, MD, PhD.

Dr. Laposata is now in a position to hope it will. As of late last year, he is the inaugural holder of a more recently endowed professorship—the Edward and Nancy Fody Chair in the Department of Pathology at Vanderbilt University School of Medicine. He is also medical director of clinical laboratories and chief of pathology services at Vanderbilt University Hospital.

Edward “Ned” Fody, MD, chief of pathology at Holland (Mich.) Hospital, says that he and his wife created the chair Dr. Laposata holds in hopes that it would allow “Vanderbilt in general and the pathology department in particular to expand and continue their leadership role in academic medicine for research, patient care, and training of students, residents, and fellows.” More specifically, Dr. Laposata adds, the Fodys’ gift will allow Vanderbilt to become a leader in an effort he has long championed: diagnostic collaboration that results in what he calls the “patient-specific, expert-driven narrative.”

Though this type of diagnostic collaboration has been discussed for more than a decade, Dr. Laposata says, it has yet to become a reality. “Because there have been so many new laboratory tests and they’ve become so complicated, and because we teach the laboratory tests so little in medical school, we now have a whole cohort of doctors who either don’t pick the right tests or don’t take the right action with the test results,” he explains. “We have known for at least 10 years that patient safety is compromised as we expand our diagnostic services and everybody throws pieces of paper at the treating physician. Vanderbilt has, as part of its commitment to personalize medicine, made a commitment to build a diagnostic team that talks together and then gives a single version of a report that represents the consensus thinking to the treating doctor. And that is very novel.”

Or rather, “there’s been a lot of thinking about it,” Dr. Laposata clarifies. “But I don’t think anybody has said, ‘Here is the budget for this, these are the expectations, and this is the timeline.’ Everybody is trying to figure out how to operationalize it, and the barriers are so significant that even well-intentioned people can’t afford to do it. I think a lot of people would like to go there, but somebody has to create the roadmap.”

That’s where the Fodys’ gift comes in. “The funds coming to me as the Fody Professor make it possible for me to not worry about generating the aliquot of money that I would otherwise be generating from other sources,” Dr. Laposata says. Instead, he can devote his time to endeavors such as: putting into place a computer program that would, for example, automatically generate an e-mail to a lung pathology expert when a patient with a lung mass has a chest x-ray, so that she knows that later she’ll likely see a fine-needle biopsy for that patient and be asked to make recommendations; creating clinical pathology interpretive diagnostic rounds; and hiring personnel to help with all of the above. A long to-do list, to be sure, but “if you look at most innovations in medicine, they look impossible at the beginning,” he says. “What Ned did, really, is create an opportunity to do this.”

As important and innovative as Vanderbilt’s diagnostic collaboration effort is, however, the Fodys made their gift with an even larger end in mind. “What I would hope it [the endowment at Vanderbilt] would do,” Dr. Fody says, “is encourage other physicians and particularly pathologists to remember how much they owe to the institutions where they trained, and to try to show the gratitude they feel in some tangible way.”