President's Desk

October 2007
A powerful new vision

Jared N. Schwartz, MD, PhD

The incoming CAP president chairs a committee that maps out strategies to achieve the College's goals. The Board of Governors asked our strategic planning committee to take on an added challenge: We were charged with devising a new vision for the College.

It's a challenging endeavor, putting poles to that tent. Structuring a vision involves balancing needs and commitments, identifying priorities, and working through a strategy. To cobble it all together, we talked to colleagues in medicine and to people from industry and other professions. We listened closely, and we read a lot before we started writing. We edited a lot, too.

This column is about the transformative power of vision, but vision is a soft concept, which makes it a tough sell. So the strategic planning committee put a lot of effort into spelling it out.

People who talk about vision often mention "thinking outside the box," which is another good idea that means different things to different people. We wanted to spell that out, too.

Our collective vision must anticipate and account for fundamental shifts now occurring in health care philosophy and medical research, shifts that will affect treatment and early disease detection. Emerging technologies and enhanced clinical focus will enable us to assume a central role on the treatment team and create a promising future for our specialty.

There's a lot of volatility, but certain premises apply. The environment of medicine is highly competitive. New technologies with promising clinical applications are emerging at an amazing rate. While we are the specialty best prepared to work with these new tools, we are physicians, not technicians. None of us went to medical school so that we could provide test results. We specialized in pathology because we wanted to work with the whole patient rather than focus on one disease or organ system. It is our grasp of the big picture that positions us as the specialists who should determine how these new technologies will best be applied to critical questions around diagnosis, prognosis, and therapy.

If the 15,000 members of the College were cross-country runners, the CAP would be our coach. The racecourse would be the distance to be covered between the here-and-now and our collective vision for pathology. The coaching strategy would be structured to grow a competitive team by building skills, creating resilience, and fostering community.

A cross-country race can cover wooded, muddy, or dusty terrain; the courses vary greatly, which means surprises for newcomers and a home-field advantage. Each team is assigned a starting position, called "the box." Mostly, it's a mind game; they like to say that the race is won or lost before the starting gun goes off. Running partners execute nuanced maneuvers to establish dominance; subtle intimidation is allowed, but it's a civilized sport.

Though microchips in runners' shoes are increasingly employed to nail down exact race times, many courses still feature the "chute," a funnel that forces runners to cross the finish line one at a time. Officials with clipboards and stopwatches stand at the entrance to the chute; standings are recorded by hand. The seconds tick down on a digital clock at the finish line as the runners sprint through that funnel.

Pathology is engaged in a civilized competition. It's a mind game, which plays to our strengths, but every one of us should be watching the clock. We are the elite athletes in medicine's race to the future because we have the broadest grasp of the fundamental nature of disease. Asserting ownership of new technologies is a key element, but our vision is not about the tools. It's about the pathologist as a superspecialist trained to understand the fundamental nature of all disease and to work with physicians in all disciplines. Our patients may see many specialists for different reasons over time, but they will always need us.

The College is a transforming agent. Through the College, we can leverage our resources to drive a transformed role for the pathologist, still the master diagnostician but now also the physician who applies emerging technologies and integrates data. In this vision, the pathologist becomes the chief knowledge officer on the treatment team.

When people share a goal, when they think like a team and focus as individuals, momentum takes over. This competition is ours to embrace, along with wonderful technologies that will speed our pursuit, enable us to work more efficiently, and significantly expand the scope of practice for our specialty. The College and its members have been training for this race—developing standards and performance measures, providing information and education, advocating for quality—for a long time.

What does it mean to enable a vision? It means to protect it with ferocity, to fuel it with commitment, to share it with fervor, and above all to believe in it. This is our arena and we have the home-field advantage. The College will hold our vision aloft as we launch out of the box and head for the chute.