Pathology
BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7164.2 (Published 10 October 1998) Cite this as: BMJ 1998;317:S2-7164
It's not all dead bodies and microscopes. William Marshall counters popular misconceptions about the pathological specialties, maps out the routes to a consultant post, and outlines the satisfactions of practice once you're there
- William Marshall
- Royal College of Pathologists, LondonSW1Y 5AF
“Pathology? No thanks! Stuck away in a lab all day, the stink of formaldehyde, other doctors' dead patients…“ Sadly, this is a common image, even among doctors. Another popular misconception, reinforced on television, is that all pathologists are forensic pathologists, dealing with suspicious deaths. But pathology is not about crime or death; it is about understanding disease and disease processes.
Forensic pathology is a small subspecialty of histopathology. Pathology's other main disciplines are chemical pathology, microbiology, haematology, and immunology. All pathologists spend some of their time working in the lab, but they do a lot more besides. Many pathologists now have direct responsibility for the care of patients, bringing the intellectual satisfaction of investigation and diagnosis with the practical satisfaction of patient care.
Chemical pathology
Also known as clinical biochemistry, a major role of this discipline is the provision of an analytical service for measuring a wide variety of analytes&emdash;”electrolytes,” enzymes, proteins, hormones, vitamins, drugs, etc&emdash;for diagnostic and management purposes. Much of this analytical work is performed by biomedical scientists using automated analysers, but the chemical pathologist is the director of the service, responsible for ensuring its quality and appropriateness and providing guidance on the selection of investigations and interpretation of their results.
Attractions and drawbacks of pathology
Attractions
Combines science and clinical practice
Rapidly advancing subspecialties
Provision of essential service
Good career prospects
Excellent training programmes
Limited on call commitments
Applications across the whole of medicine
Multidisciplinary working environment
Opportunities for pure and collaborative research
Opportunities for audit
Drawbacks
Misunderstood by many&emdash;the “back room” image
Often underresourced
Involvement in and responsibility for laboratory management although this is an attraction for many doctors)
Chemical pathologists may perform some of the tests themselves, particularly dynamic endocrine tests. They consult on the investigation and management of patients with metabolic disorders, and, increasingly, have direct …