November 2011

Stanley J. Robboy, MD

Able, willing, and ready?

In 1969, I was a third-year resident in pathology at the Massachusetts General Hospital. My chief, Benjamin Castleman, MD, was already a legend.

It’s hard to say for certain, but I suspect that I had hoped to impress him when I asked point-blank what he thought would be the next hot area in pathology and what I might pursue.

He stared at me as if he had never heard a dumber question. There was a painful pause. Then he offered a four-word reply: “Blow with the wind.”

I didn’t get it, but it came to me in time.

Then, as now, so much was just opening up; the opportunities seemed unlimited. Overthinking it, he was saying, would be a mistake. Pathology is the most engaging and challenging of all medical specialties: Embrace it!

This won’t be a history column, but it’s worth noting that pathology’s affinity with science has made it a transformative specialty all along. I trained 20 years before universities began to network their computers. It was not until 1991 that Tim Berners-Lee and his colleagues at CERN launched the World Wide Web. Yet consider what we take for granted today and how information processing has exploded.

Society’s yen for technology has been good for pathology; when smartphones appeared, we fit right in. We have always been innovators and early adopters and we have seized each in turn: molecular diagnostics, whole genome sequencing, informatics, and digital imaging, to name a few. Whatever tools and techniques are at hand, we engage.

I was thinking about all this during the National Member Conversation at CAP ’11 in Dallas, which nearly 400 pathologists attended. Much of the content was structured to launch the CAP Peer2Peer local practice roundtables that are taking place across the country over the next year.

The Peer2Peer practice roundtables are meetings of individual practice groups facilitated by a peer pathologist conversation leader. The idea is to provide a forum to talk about the challenges in our communities, sharing solutions and giving the CAP a picture of what is important to our members right now. They have been launched because we are realizing that the message of transformation will not be complete until it is shared and interpreted at the practice level. Over time, we plan to host 100 of these meetings, and afterward we hope participants will use an interactive CAP peer-to-peer forum to stay in touch and give one another advice and support.

Paul Valenstein, MD, the CAP’s new secretary-treasurer and immediate past chair of the Council on Scientific Affairs, hosted a remarkable interactive National Member Conversation at CAP ’11, during which he led us skillfully along the path to competitive resilience. We collaborated to identify perceived threats to our practices, what we saw as the causes of those threats, what we hoped to do about them, and what resources or assistance would be welcome.

I shared a table with two pathologists, one from an affluent Middle Eastern country and another from a large practice in the Midwest. We were surprised to find that our challenges and needs in terms of respect, support, and resources were remarkably consistent. Pathology is an international specialty and so much of what we face is universal.

Dr. Valenstein, in grand style, was blunt as needed and humorous at turns, driving home critical and sometimes painful points. Heads nodded in agreement when he talked about transformation as a process of taking on new roles and doing what is needed. I loved his interpretation of an old cliché: “In managing change on the scale before us, it’s not ‘Are we ready, willing, and able?’ It’s ‘Are we able, willing, and ready?’”

First, he said, we must be able—in possession of the knowledge we will need to be a molecular test consultant, biorepository director, chief information officer, or whatever role we plan to assume. Next, we must be willing—persuaded that we will be better off if we spend part of our day working in this new role. And finally, we must be ready—we must conclude that of all the changes we are able and willing to make, the most important is the change we make today. This journey should be exhilarating.

Readiness may be the challenge; not everyone is prepared to jump. The Peer2Peer practice roundtables will help with that as they enable group practices to identify the best ways to distinguish themselves in the evolving landscape. By coming together at home to talk about what is on our minds, we enable one another to blow with the wind.