July 2011

Stephen N. Bauer, MD

Our job to start the conversation

Somebody sent me a link to the Big Think Web site (http://bigthink.com/), whose editors recruit experts with a knack for demystifying the complex. For example, one Big Think video features National Institutes of Health director Francis Collins, MD, PhD, who uses a simile to describe personalized medicine. Chemotherapy is like turning off the lights in your kitchen by nuking your house, he says; personalized medicine is like flipping a switch instead.

It’s an engaging site. Part of the attraction, I think, is that they’re into something much like what pathologists do when collaborating with colleagues in direct patient care. Granted, the topics are all over the place, but in each case the Big Think expert analyzes, integrates, and presents new information, providing the context that makes it meaningful and offering direction (or educated speculation) on what the new knowledge may portend. Like pathologists, their experts provide the essential synthesis without which all data are meaningless.

Cartographer Frank Jacobs contributes the Strange Maps blog on Big Think. Nearly 600,000 people have checked out a map of the U.S. where each state’s name is replaced with the name of the country that has the most closely matching gross domestic product (http://bigthink.com/ideas/21182). What emerges is a stark gestalt of relative affluence worldwide; by this measure, only seven countries in the world have GDPs greater than that of California.

Other maps (http://bigthink.com/ideas/38766) point out where each state most excels and disappoints on data points tied to health and well-being. Oregon has the most breastfed infants and the most homeless people. Nevada has the least public corruption and the most violence against women. Arizona is at once the sunniest state and the one with the most alcoholism.

Does sunshine promote moonshine? Not likely! The Strange Maps are based on random data; they are more philosophical than scientific. Yet in aggregate, these observations tell a story about what we emphasize and value. More than anything, I think, they provide a fresh perspective.

Healing begins with a pathologist’s diagnosis. Our work is key to high-quality, cost-effective, patient-centered care. Technologies are evolving quickly, becoming powerful adjuncts to the educated mind. The pathologist’s ability to synthesize what emerges from microscopic study, noninvasive imaging, and in vivo diagnostic tools like endoscopic microscopy will make evidence-based solutions available to more patients. This is the big-picture, fresh-perspective gestalt of 21st century evidence-based medicine.

Pathologists are the “data doctors.” We are responsible for rapid and effective synthesis of the information stream that fuels evidence-based, individualized patient care. But before the technical comes the medical: We are physicians first. And that confers a duty to communicate the meaning of what we find—clearly, accurately, and in context. When appropriate, our status as physicians also enables us to suggest the best treatment alternatives for each patient, to monitor progress, and to share our thoughts about the potential implications for ongoing clinical decisionmaking.

Not long ago, pathologists could effectively communicate findings in a written pathology report. Today, while accurate documentation remains extremely important, it is increasingly

insufficient. The technologies we work with are often so new and so complex that personal conversations with our colleagues in direct patient care are often the best way to explore next steps. It is our job to begin those conversations.

Transformational pathologists develop relationships with other specialists that enable clinical decisionmaking that is collaborative and evidence-based. There are many ways to develop collegiality. A telephone call to suggest a new test might be one; an offer to join rounds or a treatment planning conference is another. Perhaps your group could invite a few colleagues to watch one of the CAP webinars that the CAP Personalized Healthcare Committee developed. We are not the only ones with an interest in new tools and techniques.

Pathologists do enjoy intellectual engagement, though, which is why I brought up Big Think and Strange Maps. It is also why I hope everyone who can join us in Dallas for CAP ’11 will do so. By the time this column arrives, it will be late but not too late to register. This meeting will be outstanding. More than 95 didactic and hands-on educational programs will be offered on AP, CP, and practice management topics, including two scientific tracks in hematopathology and dermatopathology. One-on-one practice consultations (in which a trained, standardized “patient” provides feedback on your effectiveness in presenting test results) are back by popular demand. The members’ town meeting on Sept. 12 will be another highlight, as will the CAP mentor program that evening.

Once a year, we come together, step back, and take it all in. This is essential to maintaining the quality of our practices, but it is also fun. So are the many opportunities to connect socially and network. Please join us when CAP ’11 convenes in September.