Professor Mike Osborn, President of Royal College of Pathologists

AUTHORS:  Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov 

In this series the Medspire team interviews doctors about their career, their specialty, the choices they have made and their advice for doctors and medical students.

Here the subject is Professor Michael Osborn, a consultant histopathologist and president of the Royal College of Pathologists. Professor Osborn divides his time between post-mortems, diagnostic gastrointestinal histopathology, bowel screening and medical education. 

A podcast of this interview is available here: 

 

How did you get where you are today?

I went to Guy’s and St Thomas’ when it was the United Medical and Dental Schools of Guy's and St Thomas', before it became GKT. For those who aren’t in London, that is basically a big medical school. About 50% of the year did a BSc, and I did one in pathology.  After graduating I did house jobs in Guildford and Guy’s, and then I did the surgical SHO rotation in St Mary’s, Paddington.

However, there weren’t many specialist registrar jobs in surgery but there was an opening in pathology so I did that rotation at St Mary’s, Northwick Park, the Royal Brompton and the Royal Marsden. I became a consultant histopathologist initially at St Mary's, but we’ve now become North West London Pathology, which is an amalgamation of Imperial College, Charing Cross, Hammersmith, and St Mary’s. 

 

What were your fondest memories from medical school?

The best thing were the friends I met at college who I’m still very friendly with and, indeed, my wife who, as of half an hour ago, I was still quite friendly with! But who knows? Lots can happen in half an hour! Plus it was a very well-organised, well-run course. The teaching was good. I couldn’t fault it really.

 

What does pathology involve?

Pathology is the study of disease and the parameters of disease. We’ve got 17 specialties within pathology, but many people think of it simply as cellular pathology, which tends to be looking down a microscope at a cancer biopsy or something like that.

But we’ve got lots of other specialties. So, for example, everything to do with blood tests, blood transfusion, and blood typing, that’s pathology. And your urea, electrolytes, your liver function tests, lipids, all of those things, that’s all pathology. And antimicrobial resistance and infection control, that’s all pathology as well.

Seventy percent of every healthcare interaction on the planet is based around a pathology test. So, it touches everything, and you can be a consultant in any of those specialties. So, you can be a chemical pathologist, a microbiologist, or a cellular pathologist. 

Then there are things like immunology which has a lot to do with the cross-matching of tissue in transplantation. Quite a lot of the people involved in that have come from a science background rather than a medicine background.

Then there’s things like forensic pathology and we even cover animals! The important thing to realise about pathology is that there is something for everybody. If you want to work in a laboratory and be very based around tests and developing new tests, you could do that.

If you want to be very patient-focussed, you could easily do that in things like immunology, microbiology, or haematology. If you want to have less patient contact, but still be important in patient care, perhaps cellular pathology would suit.

 

What initially attracted you to pathology as a career?

I was always quite good at biology at school and that’s why I did medicine, because medicine is basically biology, isn’t it? And I was always quite interested in the disease side of it and I had a really good time doing a BSc in pathology at medical school. It was taught very, very well in our medical school. We had some really good fun, inspiring teachers.

So, all of those things fed into it. But I thought psychiatry was fascinating, too, and I thought about medicine and surgery as well. Most people would be quite happy doing lots of different specialties. It’s just a bit of chance, which one happens to be the one that sparks your interest at the time, and there’s no such thing as a bad specialty, to be honest.

They’re all really good and it just depends what suits you, and pathology seemed to be like that and it’s been very good. It’s as simple as that.

 

You initially did basic surgical training. People might think that pathology and surgery are quite different. How did you find that?

I’m a cellular pathologist and I look mainly at gastrointestinal tissue, so gut resections, GI cancer, inflammatory bowel disease, bowel cancer screening. That’s quite linked in with surgery, because the stuff you’re looking at is very surgically-based; things like margins and stage of disease.

At the time I just wanted to do some more clinical stuff so I did a surgical rotation. If things had been different and there’d been lots of surgical jobs, I’d have probably ended up doing that.

As it happens I’d have probably been quite a bad surgeon because I’ve got quite a bad resting tremor! Most people who did pathology then had done a different specialty first. It’s less common now, but it was quite common in those times.

 

What are your current clinical interests?

North West London Pathology is basically an NHS provider of pathology services to a variety of NHS trusts in London. I do diagnostic pathology, which is basically gastrointestinal pathology, particularly things like cancer, and I do bowel cancer screening, too.

Also I do quite a lot of undergraduate teaching, because we’re part of Imperial College. I run a BSc, which is actually a humanities BSc. It’s called Humanities, Philosophy and Law, and I run it with a variety of other people who are very expert in humanities and law and things. So, I do that and I do quite a lot of post-mortems as well.

 

How can someone interested in pathology as a career expose themselves to it?

The important thing to realise is that you’re exposed to pathology all the time. Every time you look at a blood test result, that is a pathology test, be it a full blood count or a U&E. So, you use pathology without even thinking and most specialties depend on cellular pathology as well.

So, whatever specialty you do, you’re utterly dependent on haematology, chemical pathology and microbiology, because you just use them all day in whatever you do. Even if they’re just telling you that the results are normal or the antibiotic is working, it’s still pathology. Most areas are also very dependent on cellular pathology.

Things like skin biopsies, lung biopsies, GI biopsies and cervical cytology and the breast screening programme are all cellular pathology. Of course most of the tests and the reporting is done in laboratories, so you won’t necessarily see where it is done. That’s why there’s a slight disconnect; it happens in the background.

But most pathology departments are happy for people to look around or do attachments and those who do find it is quite a good specialty. 

It’s got a lot of advantages because there are lots of jobs. If you want to do research, pathology is very, very good for research. Research people are always after pathologists because there aren’t enough of them. You don’t even have to be a dedicated academic. You can be involved in proper high-level research, even as a jobbing pathologist.

The other thing is, in some of our specialties, there’s no on-call, so it can be very family friendly and it’s quite flexible. Most pathologists are relatively happy most of the time. 

 

What kind of doctor would enjoy pathology as a career?

I don’t think there is a particular sort of person who pathology would suit because there’s such a wide-range of specialties. Whatever sort of person you are, there will be a job that suits you really, really well and you will really enjoy.

From the most gregarious to the most introverted, there will be a jobs to suit. I work with all types of people, all different ages, from all around the world, men and women. It’s hugely varied and diverse. There’s no standard person.

Attention to detail is an advantage, but I think that’s probably true for all medicine. My advice to medical students or someone at FY1 is that it is a really good specialty. There are a whole range of things you can do, whatever you’re looking for.

It’s a very good career. There are lots of jobs available wherever you may want to work - in this country or around the world. There’s lots of opportunities for research, lots of opportunities for teaching. It’s very family-friendly

 

What made you run for president?

I’ve been involved with the college for quite a long time. I just got involved because somebody suggested that I should take on a role and I applied for it and it developed from there. Initially, I was one of the trainee reps. Then I got involved in an NCEPOD study, and then I got asked to be on various committees, and I got more and more involved.

As for the presidency, it was an interesting role and something that I thought I would enjoy and could probably bring something to. It was a natural progression based on my previous experience. 

 

What does pathology training involve?

The pathology curriculum varies between our different specialties; the training for microbiology is different from the training for haematology. There’s no core training. So, it all depends what specialty you are but, in the broadest terms, you will do a tailor-made training programme for your specialty.

Some of our specialties are linked with other colleges, particularly the Royal College of Physicians. Things like haematology and microbiology have components that are very medically physician’y-based. A medical microbiologist will have sections that are attached to wards doing infection-based stuff, antimicrobial resistance stuff, and then there’ll be other sections attached to the laboratory, learning about the laboratory test side of things.

On the other hand, cellular pathology generally doesn’t have a ward-based or a patient-facing component. For most of it, you’ll be based in a laboratory learning how to take the samples from the specimens that are sent and then learning how to report them in the correct way. But you’ll attend multi-disciplinary team meetings and interact with more clinical colleagues. 

For some specialties, like haematology, it's a dual specialty and there would be a physician component as well. But, usually, it’s a combination of patient-facing or more patient-facing things, be they clinics or ward rounds or whatever, and then more laboratory-based stuff, learning about the tests and so forth.

 

What are the most pressing issues facing pathologist?

The biggest thing is the workforce issue. Pathology has been under-invested in and it’s been forgotten about for a long, long, long time. There’s a significant lack of workforce because the training posts haven’t been expanded to meet the increased workload.

Also, recruitment is difficult because there just aren’t enough consultants. And the issue has been compounded by the Covid backlog. We’re also handicapped by the fact we’ve got old, out-dated computers and laboratory information management systems.

They need to be updated and that would make things like ordering much more efficient. Also, we’re pushing to have a national roll-out of digital reporting which would make things a lot quicker.

There are two other areas. Genomics is being rolled out nationally. Genomics is huge. It’s very exciting. It’s going to allow tailor-made medicine but that needs pathologists, particularly around things like tumour markers. You need pathologists to mark out a tumour and make sure it is there on the specimen so it can be tested.

Also, the pathways need to be smoothed out, so that it’s easy to take a biopsy in a clinic and get the results back quickly into the notes. That whole process is very bumpy at the moment, and that needs to be sorted out.

The other area - which doesn’t get as much recognition as it should – is antimicrobial resistance. Antimicrobial resistance is always number three on the list of the most important medical things going on in the world, but it never goes above that. It’s a bit like painting your shed: you know it needs to be done, everybody knows it needs to be done, but it doesn’t necessarily need to be done today!

But if you keep putting it off, one day your shed will fall down, so you’ve got to grasp the nettle and go and paint your shed. It's a bit like that with antimicrobial resistance. Everybody knows it’s there, everybody knows it’s important, but there’s always something else more acutely important. 

 

What is the college doing to try and improve the situation?

The risk of antimicrobial resistance can’t be over-emphasised. If you go back 200 years to before antibiotics existed and before there was good infection control and sanitisation and all these sorts of things, there were terrible bouts of infectious disease. Even at the turn of the 1900s, loads of people died from what we would consider to be simple infectious diseases that are easily treated by antibiotics. The trouble is, people take them for granted.

It’s unlikely you’re going to get a situation where, overnight, you’ve suddenly got resistance to all antibiotic but gradually you get emerging strains that just make things harder and harder and harder to treat, and it just means people spend longer in hospital. There’s more morbidity, there’s more mortality.

Think of a hip operation. Suddenly it becomes a massively significant problem because there’s a much higher risk if you can’t treat wound infections. And that’s just in this country. In less developed countries simple antibiotics can be absolutely life-changing for huge cohorts of the population. So, we’ve got to make sure there are new antibiotics because, otherwise, even mild infections become a real problem.

At one end you’ll have the misery of ear infections that won’t get better but at the other end you will have wound infections or chest infections that get worse and worse, and on a worldwide scale. 

What’s the College doing? We’re integral to dealing with this because we’re the college that trains microbiologists who are the people who deal with this and they’re massively au-fait with it and the issues around it and work very hard to look after the use of antibiotics with pharmacy colleagues and so forth.

More than that, we’re trying to set up an organisation to really champion antimicrobial resistance and lobby government and other stakeholders to make sure it’s taken into account moving forward in everything that we do. 

 

What practical advice can you give to doctors about antibiotic stewardship? 

The key thing is to follow the advice you're given by pharmacists, by microbiologists and the prescribing advice, which takes antimicrobial stewardship into consideration. So, if they say, ‘Use this antibiotic A,’ then I would suggest you use that, if it’s appropriate, because the reason that they’ve suggested it will take into account antibiotic and antimicrobial stewardship.

And hen the nice pharmacist comes along with the green pen and scores out your choice, don’t take it personally, as I used to. They have saved more reputations and patient lives than anybody else in the health service, I would think, with their green pens. So, hold them in very high regard. They’re the stewards of antimicrobial stewardship really, working with infection control and microbiologists.

Lots of people blame GPs because they hand out antibiotics. But it’s very difficult if you’re in a GP practice and things are really busy, and you’ve got really demanding patients, possibly being very vocal that they want antibiotics. So, don’t blame them. It’s not a blame game.

 

What are your key priorities?

We’ve had Covid and the running of the College has been difficult. As we come out of the acute phase, we need to maintain our core activities, like developing clinical excellence and guidelines for our members around things like antimicrobial resistance and minimum datasets for cancer. And we need to make sure we’re involved in the national roll-out of genomics, which is going to affect all of us going forward.

We’re developing the Antimicrobial Resistance Alliance to try and build up antimicrobials and we’re constantly trying to increase workforce and highlight to the relevant parties that pathology must not be forgotten.

 

Has Covid put pathology back under the spotlight?

That’s a good question. Everybody says that diagnostics is now in a resurgence and everybody’s taking it very seriously, but I still go to lots of meetings where pathology is forgotten. They’re talking about the development of a new cancer pathway or something and no-one’s thought about the fact that the biopsy has to be processed and the blood tests have to be done somewhere.

So, while most people know what diagnostics and pathology are in the broadest sense now, we still have quite a lot of work to do to make sure we’re included in the discussions.

 

How did International Pathology Day go?

It was really good. We have got quite a lot of international members around the world, who either trained here or have links to us, and we’ve got exam centres in different parts of the world. And the discussion was very interesting, particularly around the use of artificial intelligence and digital technologies for pathology, which offer different things to different parts of the world.

That might be increasing the workforce in this country with digital reporting or maximising what a very small number of pathologists are able to do in another. If AI systems can sift out what a pathologist really needs to look at, you can use their time more efficiently. 

 

How can medical students and doctors get involved with the college?

We’ve got a page on the college website about how to get involved. Anything from being involved regionally, to being an examiner, to being on the council, to running for president or vice-president. All the information is there. And if you’re doing pathology, speak to the people in the pathology department.

Almost every pathology department will have people who are linked to the college or who have had roles in the College, and they will be very happy to talk to you about it and put you in touch. 

And if not, just email the college and they will respond. Everybody’s got something to offer to the college. For some, that will be setting exam questions or being an examiner. For others, it will be writing the datasets to highlight the best practice guidelines. 

 

What are your proudest achievements?

Well, becoming President of the Royal College is probably my proudest achievement so far. Passing my medical exams. That was, simultaneously proud but a relief as well! It made my mum happy. So, that’s always nice, isn’t it? I ran the London Marathon a couple of times. I was quite proud about that. 

 

Is there any advice that you wish you’d been given as a medical student or a junior doctor?

I was very lucky in that I had very good people at my medical school and I worked for very good consultants who were very reasonable and very good at giving advice. Somebody said to me that you should just try and take all the opportunities that come up.

It may seem like a bit of work but, usually, those things are worth doing. It may not be something you ever thought of doing, but that doesn’t mean you’re not going to enjoy it. 

 

Have there been any key role models for you that have shaped you as a clinician or a leader?

Role models? Wow. Role models? I don’t know, it’s not something I’ve thought about really. That’s a difficult question. I’m supposed to say people like Winston Churchill and Abraham Lincoln and Mother Teresa, aren’t I? Those are people that everybody gets inspiration from, aren’t they?

Probably not Donald Trump. Definitely not Donald Trump. There’s bits and pieces of lots of people who are inspirational, but I suspect my inspirational people are pretty much the ones that everybody would say. You know, Nelson Mandela, but not Donald Trump.

 

What about people during your career that have had an impact on you?

Oh, I could honestly list all of the people that I had as bosses. They were very good and they were very good at supporting their staff even if they knew you didn’t necessarily want to do their specialty. I think that’s an important thing for senior people to remember.

Just because somebody doesn’t want to do your specialty, it doesn’t mean you shouldn’t support them and help them. I was fortunate enough to have people like that. I’ve lived a bit of a blessed existence really.

 

What’s your favourite book?

Oh, ‘To Kill a Mockingbird’. That was easy. This goes back, you see. For my O level English, we were the class that didn’t get that book. We got ‘David Copperfield’, which is also quite a good book. Anyway, two or three years ago a new film of ‘To Kill a Mockingbird’ came out and my wife told me I should read the book because it was fantastic, and it is.

 

Medspire podcasts are produced by Dr Sanketh Rampes and Dr Anvarjon Mukhammadaminov, both full-time junior doctors. They aim to inspire the next generation of doctors and scientists by exploring the career journeys of leading clinicians and researchers.