November 2009

Stephen N. Bauer, MD

Late this summer, about a week before my daughter was to be married, I was working on wedding projects in the garage when several small birds created a ruckus beneath the porch. Songbirds have nested there before but it was the wrong time of year. I went to look. No nest, but there was a bit of grey between two supports. I stepped up on a bench to get a closer look and encountered an owl staring back; I was much more startled than he.

The owl came back the next several days. I wasn’t sure this was a good spot for him to reside, so I called a birder friend. We identified him as a Western Screech-Owl, known as a “master of disguise” because it so easily blends into its surroundings. On the Web I found out that this species will often take up residence in man-made boxes with a particular design, so I built one that evening and installed it in a tree outside my study. A couple of days later, there he was, head sticking out of the box, surveying the yard. Now I enjoy watching him watch us and seeing him fly off at night to hunt. I hope there’s a mate in the neighborhood and they’ll nest in the box; while not endangered, their numbers have been decreasing with urbanization.

If I were to show this introduction to my relentlessly logical newlywed daughter, I’m sure she’d question where I was going with it. I would tell her that maybe I’d been thinking about building new homes, or about species (like daughters) whose numbers are declining in the neighborhood; maybe I’d been thinking about that baseball movie where Kevin Costner builds a stadium in a cornfield because, the wise man says, if you build it, they will come; maybe I was thinking about how it may not always be best to let nature take its course. And all of that would be true.

If she were still listening, I might tell her that just as the Western Screech-Owl doesn’t screech, not every bird house that is built will live up to its name or be used to its full potential as a home where occupants nest and incubate their dreams.

As our professional home, the CAP needs to be a large house, accommodating our extended family, including the 49 state pathology societies. Things happen fast at the local level. We depend on our state societies to respond to local issues that can mushroom into national problems and let us know when trouble is brewing.

The practice of medicine is largely regulated by the states, and in recent years almost all of the state pathology societies have partnered with the CAP in responding to one or more of some 150 state legislative proposals, including poorly conceived bills that threaten patient safety. Bills were introduced this past spring in California and New York to exempt from state clinical laboratory regulations certain genetic testing offered directly to consumers without a physician order, including single nucleotide polymorphism analysis for disease risk prediction. If enacted, both bills would undermine existing state laws and potentially also the Clinical Laboratory Improvement Amendments of 1988. Alert leaders within both state pathology societies, partnering with the CAP, have been opposing the legislation and educating legislators about the dangers of these bills. In New York the state medical society also opposes the legislation. Both proposals are still on the table, but our advocacy teams are in place and their arguments have credibility. Legislators appreciate informed input from constituents motivated by a genuine commitment to the public health.

This July, Connecticut became the 16th state to prohibit an ordering physician from billing patients for anatomic pathology services performed or supervised by another physician. In May, the Nebraska state legislature became the 16th to pass a bill (supported by the state pathology society and state medical society) requiring that ordering physicians billing for anatomic pathology services disclose the identity of those performing the services and the amount actually paid. In each case, CAP support was significant, but involvement of the state societies was critical. We cannot win at the state level without them.

Pathologists who do their homework, know the issues, and make the time to give their legislators clear, credible information are the bricks and mortar of this warm home. The CAP member who picks up the telephone to arrange a laboratory tour for his or her local legislators—and pathologists have conducted 46 laboratory tours for their legislators over the past two years—are front-line educators and exemplary representatives of our specialty, providing a local perspective on state or federal issues.

State pathology societies should be able to assert that they represent the collective opinion of pathology in their states, which is why every state pathology society should have 100 percent participation. Writing a check is where it starts, but more than that, your state society needs ongoing personal commitment.

As former House speaker Tip O’Neill famously said, all politics is local. The opinions of the voters back home will be heard. Without strong state pathology societies to articulate and advocate for sound state and national public policies, we could find ourselves with a health care system based on anecdote.

The coming winter may be blustery, cold, and dark; we will be looking to our state societies for heat and light. Please regard state membership as a personal mandate. Go to the CAP Web site and click on the link to your state pathology society. It’s time to stand up.