Pathology group efforts in the general behalf
of Lexington County Health Services District (LCHSD) patients
(Lexington Medical Center, West Columbia, S. C.)
"No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering, he needs technical
skill, scientific knowledge, and human understanding. He who uses these with courage, with humility, and with wisdom will provide a unique service for his fellow man,
and will build an enduring edifice of character within himself...1". We feel that
the most effective medical practice is "at the point of service"...medical practice focused locally [as pathologists: "
point of service pathology"].
Additionally: ***OUR GOAL IS A TEAM THAT WILL PERFORM IN THE MANNER OF A LOCAL PROFESSIONAL "CALLING" RATHER THAN JUST A JOB OR BRIEF TOUR POINT IN A CAREER.
To people considering a physician career in pathology, we pathologists
are able to be researchers, teachers, practitioners, or a combination
of these 3 broad spheres of any medical career. In the physician specialty
of Pathology and Laboratory Medicine, we are fortunate to be
medical doctors (physicians) who have access to the entire
breadth & depth of medical practice, both specifically
with individual patients...or in general, as it relates to
a medical community of varying size. A career of 30 years in
pathology can easily leave one claiming to never having had
a boring day in the career. We can be involved (& even
in physical contact) with patients as much or as little as
we like (or as the need is manifest). At the end of each practice
day (if we desire to practice that way), we are able to be
confident that we have made a positive difference in several
to a dozen or more patient's lives.
In chosing where to practice, teach, or research, we can testify that "things can change". Our situation is within a county converging 3 interstate highways, 4
railroad lines, and 2 public airports. The county boasts beautiful Lake Murray. Since at least 1970, it has maintained an excellently growing public school system. And the
local hospital (founded in 1971 as a county hospital) is an excellent & growing health care system functioning as a county-government-associated, independent "health care district
" (LCHSD). Highways, rail lines and the lake happened because of nearby Columbia, South Carolina's capitol city. Success in terms of causing outcomes in the best
interests of students in schools and patients in hospitals & health care systems requires
character-rich, competency-rich leadership and a surrounding community with favorable demographics (money). Our
group is one component of a very strong collection of hospital-based physician groups whose inter-departmental, long-cooperative talents are the key to the original & ongoing
success of the health system. Therefore, the ability of these groups to grow in a way that allows top priority focus on top quality patient care is crucial. Will the
Lexington County Health Services District (LCHSD) leadership countinue the original foresight or not?
One of the more effective & positively impressive laboratory
chief medical technologist we've known (Frank Defrenza) said
something like, "Since they don't know what they are doing [as to in-hospital labs],
you have to do what you have to do to make things work as they
should". Our view is expressed more professionally & diplomatically:
through local, national, and international professional organizations,
through institutional and/or business/corporate hierarchy,
and within physician practice groups, excellence in personal & professional
character must be exerted & prevail for the sake of quality
patient care. There are just too many administrative types...even
physician types...in "the average system" who cannot (even
though they may earnestly want to) adequately understand the medical
factors and what is at stake, medically, unless we professionals
can develop the relationships of trust which might lead to
understanding. And, we pathologists may be greater or less than optimal
in our ability to teach and persuade. Depending on the practice
situation we chose (or simply land in) and our personal willingness & character,
we can have from none to great degrees of impact on the quality
of medical care in our variable spheres of influence. We of
Pathology Associates of Lexington, P. A., find ourselves to
be a mix of practitioners, teachers, and practical-applied
researchers focused on the catchment area of an excellent acute
care general community hospital (our
group & links to CVs/resumes).
First, Do No Harm!
Parisian pathologist and treater of living patients, Auguste F. Chomel's (1788-1858)...or was it Thomas Sydenham (1624-1689), fundamental advice to all physicians was primum non nocere (to "first do no harm") & is the title of this segment. If we (members of our pathology group) become patients somewhere,
we hope that the Department of Pathology & Laboratory Medicine
is medically directed by well trained pathologists who have
highly developed & operational content
of character & professionalism (relational and standard
of care application skills way beyond "just a job").
The logo at the top of this page shows the caduceus
to the left...the symbol for physicians as a classical learned professional
group (there is a long educational road to get there). To the
right is a brain; great numbers of people have fine brains & high
IQs...you don't get to be a physician without that brainpower. But brainpower is only part of what is needed for success.
The medical degree and the brain don't guarantee high character (the individual expressional outcome of personal lifelong incorporation of virtues).
It was said in a major pathology text of about 1984, commenting about histological diagnosis, "Despite man's ingenuity in inventing amazingly sophisticated
instrumentation, the anatomic diagnosis of neoplasms is largely accomplished by 'eyeballing'. In some part a science, and in large part an art, it
is heavily dependent on the brain behind the eyes behind the microscope2
." And we'd add
that the character behind the eyes and brain is even
Character over-arches the foundations of training & seasoning
excellence and professionalism. It is what causes the pathologist
to (1) desire to "keep up", to (2) go "the second mile" or more, to (3)
go "above and beyond the call of duty" in both specific & general
behalf of patients, and to (4) reject temptations to be unethical & to practice by strong ethical standards. Most of our website content implies
efforts in behalf of a specific individual patient's diagnosis. To the extent that a pathologist can do so, we want to be involved in treating the patient (Patch Adams
quote: "You treat a disease, you win, you lose. You treat a person I'll guarantee you'll win."). Though we are "for" the individualized patient, the following
discussion and illustrations and links tend to reflect issues
in the general behalf of all patients.
What do community-hospital pathologists do?
- We make diagnoses (TOC)
on patients from blood or bone marrow smears, from specimens
removed at surgery or various biopsy procedures or from cytology
preparations taken from various body sites (such as Pap smears),
or from findings after death in autopsies. [The
aforementioned are common to almost all community-hospital
pathologists; the entirety of what follows may not apply. Or the issues may be found
on a wide spectrum of "almost involvement" to "intense
involvement" (our group is intensely involved).] Some
groups try to staff with specialists, some with generalists,
and some (ours...a comment) with a
mix...and with staffing at a proper level and with the benefit of time for annual
leave to maintain continuing education and to recharge the freshness
to be thorough & stay intense. Those diagnoses are rendered into an official
pathology report which has many issues in mind as the report
is composed [commentary about
- In anatomic pathology, we use technically ever-morphing basic tecniques of examining slides in a process that has advanced the practice of medicine for over 150 years. Since 1980,
there have been additions of amazing ANCILLARY techniques [example = IHC] which enter practice with the promise of changing things so that diagnoses are no longer at all
subjective. In a conference in early 2008, one internationally recognized expert...echoing many experts during the week, made a brief commentary about "new technology" which I am paraphrasing as a quote with which we fully agree: "Diagnosis steps warning: (1) top priority is the eyes & brain of the
pathologist [the thing that insufficient staffing &
helter-skelter affects most dangerously]; followed by
(2) excellent fixation & good H&E; followed by (3)
well done ancillary studies of all types judiciously
used to test/confirm the pathologist's DDX formulated
in the context of as much known clinical info as
he/she can get his/her hands on (anatomic path DX
without need for clin info becomes dangerous on small
- And, more globally, we medically direct the
workings of the entire hospital laboratory, [as follows] and
[here] . It has been pointed out that laboratorians will be held accountable for noncompliant laboratory testing in a health
care entity, the JCAHO requiring a single standard of care throughout an organization3.
- For students considering a career in pathology: [ASIP]
Back To Top
- Bryan CS, "The Seven Basic Virtues in Medicine: Summing Up", in which he quotes the opening paragraph of the first 9 editions of Harrison's Principles of Internal Medicine, J. SCMA 103 (5):135, June 2007.
- Robbins SL (1915-2003) & Cotran RS (1932-2000), textbook of pathology, last carried on page 265 in the 3rd Edition (1984) and not as an actual quotation; in searching for whom to ascribe
this quote to, I contacted Drs. W. A. Gardner @ AFIP and Dr. William H. Hartmann, retired, in June 2007; Dr. Gardner thought it might have been Dr. Fred W. Stewart (__) or Dr. Lauren
V. Ackerman (1905-1993). Dr. Hartmann thought it might have been Dr. Stewart or Dr. James Ewing (1866-1943) and not what Drs. Ackerman, Cotran, Robbins, or Kumar would have said.
- Ng VL, et. al., "POCT in the ED", ADVANCE for Medical Laboratory Professionals, p10-12, 5 November 2007.
- Mahul Amin, MD, chair of Dept. Path. & Lab. Med. @ Cedars-Sinai Med. Ctr in Los Angeles, Calif. Co-author of current WHO manual for GU & Renal neoplasms & two AFIP fascicles & a monograph on Gleason scoring & a founding member of AJCC. He was a speaker at The Second International Course in Applied Immunohistochemistry and Molecular Pathology (Santa Barbara, Calif. 1/28/08-2/1/08).
| (posted 22 December 2004; latest addition 30 January