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Histopathology and medical laboratory scientific officers Pathologists are responsible for diagnosis

BMJ 1994; 309 doi: (Published 24 September 1994) Cite this as: BMJ 1994;309:803
  1. D H Wright

    EDITOR, - T G Ashworth was correct when he predicted that his views would incur the displeasure of some of his peers.1 In the interest of job satisfaction and economy he advocates that medical laboratory scientific officers should undertake the gross examination of surgical specimens and the microscopical examination of some unspecified tissues. He states that, for 50 years, his laboratory has entrusted the selection of tissue for embedding and microscopy to medical laboratory scientific officers and he knows of no instance in which this practice has led to diagnostic error. Without the aid of external audit what is this statement worth?

    Undoubtedly, medical laboratory scientific officers could be trained to describe and dissect many surgical specimens and to select appropriate tissues for histological examination, but they do not have the appropriate background for this. Is it cost effective to train staff for jobs for which they have inadequate background experience and education? While the medical laboratory scientific officers are undertaking these tasks who does the skilled work for which they have been trained?

    If a medical laboratory scientific officer misses an early neoplasm in a specimen (for example, an adenocarcinoma in a distorted fibrotic sigmoid colon resected for diverticulosis) who will be responsible? Finally, this separation of gross from microscopical examination increases the chances of diagnostic error. Gross examination is an integral part of diagnostic histopathology, and the findings on gross examination not infrequently modify the interpretation of the microscopical appearances.

    With respect to the reporting of microscopical examinations, I am not sure what Ashworth means when he says, “All histopathologists know the lesions to which I am referring, those that require simple, objective answers and which can be easily verified.” Does he mean appendixes and gall bladders, when the debate often revolves around whether they should be …

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