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From the President’s Desk: The deep roots of tall trees, 2/17

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Friedberg

Dr. Friedberg

February 2017—One of my mentors, Richard E. Horowitz, MD, is thoughtful, perceptive, persuasive, and calmly persistent. He is a pathologist to the core, the physician inseparable from the scientist. When he wants to know something, he asks—and there’s plenty he wants to know. He is an emeritus professor of pathology with a long string of leadership credits, so he knows where to look for answers to deep questions. And his seemingly irrepressible inclination to mentor younger pathologists nurtures pragmatic leaders who can move our specialty forward.

Dr. Horowitz has always maintained that a well-rounded medical education should incorporate practice management. He even organized independent employer surveys to show the need for practice management training in medical school curricula. The data he collected have set the ball to roll in the right direction more than once.

Richard is in his mid-80s and remains mentally sharp, so it’s always a pleasure to receive an email from him. One arrived recently with an editorial, titled “Pathology’s Stepchild,” he coauthored with Sarah M. Bean, MD, for the February 2017 issue of Archives of Pathology & Laboratory Medicine (141[2]:186–187). Their editorial concerns the importance of a solid education in clinical chemistry. Richard asked for my thoughts, so I read it right away. Much of what they discuss about clinical chemistry and the expansion of technology in pathology is highly relevant for all of medicine. We all need to understand the fundamentals in order to fully integrate that knowledge into patient care. The editorial is excellent and well worth your time.

Richard also attached a letter to the editor of the Wall Street Journal in which he used his personal experience as a lung cancer patient to advocate for including autopsy findings among critical outcome and performance measures. Though a bit outside the Wall Street Journal’s traditional sandbox, it was printed (Sept. 17, 2016). Then again, Richard is one of pathology’s tall trees and those are not hard to spot, towering above as they do.

In any field, the tall trees shelter, nourish, nudge, and encourage. They provide a canopy beneath which we can learn, grow, and evolve. And just as the soaring sequoia owes its vitality to the complex root structure below, leaders like Dr. Horowitz remind us of the many ways pathologists move medicine forward. Pathology is all about the fundamentals, and it is those fundamentals that drive durable progress.

Yet it is precisely because our work is so foundational that we have a notoriously low profile within our institutions. Fixing that has some urgency, because recognition confers authority. If we do not collect and share evidence to show our value, nobody will. Each laboratory team should collect data that show the exact scope and depth of its services and take steps to remain relevant and efficient. It’s not difficult; after all, we are data people. And our inclination to quantify can be an asset.

For example, a few years ago our entire group completed simple daily time sheets for two weeks, tracking hours bucketed into one of four domains: research, teaching, administration, and clinical service. When viewed in aggregate, our numbers independently validated data the hospital had collected for years but didn’t trust. We also found comparable data from similar institutions in our region. So, when I was challenged recently by high-level administrators under the assumption that we were overstaffed, I already had the data to prove otherwise. Surveys and comparables trumped gut feelings. Data speaks volumes.

To this end, I’d like to urge everyone whose laboratories are enrolled in CAP laboratory accreditation or proficiency testing to review the CAP Performance Analytics Dashboard launched this past summer. The dashboard is a wonderful online resource, available without charge, that provides an on-demand report with which laboratory staff can identify concerning trends or patterns. The dashboard gives visual cues that corrective action may be needed and benchmarks performance while filtering out nonessential artifacts. Laboratory networks can use it to identify systemwide issues by department, discipline, or analyte; benchmark individual laboratories against the system as a whole; and improve efficiency.

When it comes to making our case for value, the quantitative component is straightforward. Qualitative elements, however, are more challenging. As I have encouraged residents during numerous grand rounds, I’d like to encourage every pathologist to create an “elevator pitch” to explain within 30 seconds what he or she does. Imagine you are in an elevator with a key individual, and you need to make the greatest impression on your captive audience before the door opens. Getting your spiel nailed down is an exercise in self-discipline (omphaloskepsis?), but the responses can be illuminating. Many physician colleagues are interested in what we do because just as it is our job to translate science for medicine, it is their job to translate medical findings for patients.

If we are less mysterious and more accessible, our colleagues will be more likely to seek our input when they endeavor to weigh and then explain their patients’ options. This has always been part of our job, but it is becoming more important as the complexity of medicine—fundamentally tied to science—continues to grow. And as technology becomes more dominant in patient care and nonphysician caregivers are asked to take on more responsibility, those caregivers will need translation help as well.

Our value emanates from the space where science and medicine intersect, and it falls to us to translate what we find there. We are physicians whose value to medicine lies in the insights of a scientist and the skills of a translator. For that reason, it will be incumbent upon us to take on more leadership roles as the health care system becomes yet more complex—and potentially less patient centric. We need to be there for our patients and our colleagues, in every discipline, with every medical concern, at every routine check and fork in the road. Where is our niche? Our niche is by their side. Every step of the way. Even when they don’t know we are there.

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Dr. Friedberg welcomes communication from CAP members. Write to him at president@cap.org.

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