The Primary Care Pathologist’s DNA
Fourteen years ago, I was proudly standing by my resident physician research poster at the annual USCAP meeting. It was the usual “brown stain tricks” poster that was the investigative standard of the day, but with enough rational experimental design and statistically significant results to attract some attention that year and even garner an award. My father, a pathologist who had been in private practice in Mississippi for 25 years, also attended the meeting. It was a time in which the father-son gorge that is relentlessly carved by the convergent raging rivers of adolescence, young adulthood, medical training one-upsmanship, and alpha-male struggle finally ceased to widen, and had begun to be connected by some tenuous bridges. In fact, as my dad repeatedly visited my poster during the Q&A sessions, I am, to this day, absolutely certain that I saw the glow of pride flicker over his seasoned, stoic face. Near the end of the Q&A session when a gaggle of judges and titular luminaries in our field were gathered around, I saw my dad stealthily circling the pack. I waved him over to join the group. Each of the gathered pathologist introduced themselves by name, academic affiliation, specialty and subspecialty interest. Given the length of the CVs of this crowd, these self-introductions were rather long – reminding me of the herald announcements of the names and dominions of princes, dukes, and countesses as they arrive at a royal ball. When it was my dad’s turn to state his pedigree – he remarked, “I’m Julian Henderson – a primary care pathologist.” My dad’s deadpan delivery created an air of uncertainty as to the degree of humor to which this line should be received – but there were a few chuckles of appreciation for his remark, and a little ensuing small talk about “towns versus gowns”. Soon the niceties subsided, and the dukes and countesses filtered into the crowd. Despite the corpus of cutting edge knowledge dispensed at that conference long ago, the only thing I remember from the meeting are the words my father said to me next, after all of the royalty had departed, when only he and I were left standing at my poster – “They are the lost generation – they have no idea what I mean by primary care pathologist – and unless your generation starts to understand what I mean, then our specialty will be obsolete.”
As I compose this first blog posting, I am marking the completion of my eleventh year as a practicing pathologist. I recently read Malcolm Gladwell’s new book Outliers in which he advances the hypothesis that it takes 10,000 hours of practice to become an expert at something – which, given the necessities of sleeping, eating, family life, etc., comes out to be about 10 years of a given life. This resonated with me, as it has only been in the past year that I have discovered that I have the feeling of finally being in the proverbial “zone” of practice. It’s not that I am not challenged – just the opposite in fact. Nor have I embraced the original medical sin of hubris – I do indeed know, now more than ever, when I don’t know. But now that I am in the zone, I’ve found myself spending a lot of the past year pondering what exactly is my expertise – what “zone” am I actually in, anyway? I mean, while my subspecialty area of expertise is breast and gynecologic pathology, and I have had my share of publications and achievements – I am not in line to receive any gold headed canes or awards named after our patriarchs. I am no prince, no duke – not even a countess. At some undefinable point this year, the answer simply came to me – the scales fell from my eyes, and the person I saw staring back at me in the mirror was a primary care pathologist. The power of one’s DNA is still astounding.
In thinking about what my father was, and what I had become, I finally decided to take the time to document just what that label primary care pathologist meant to both my dad and I. And such is the genesis of this blog. My purpose in writing, as often as time will allow, is to offer up to my colleagues in pathology and in medicine, to those who run our healthcare systems, and to those who are under the delusion that pathologists are fashionable, attractive, yet quirky, people who spend their time solving complex forensic crimes in high tech laboratories that have the design and lighting of a hip urban chill-out lounge some regular field reports, thoughts, musings – logical and irrational – from the front lines of the practice of pathology and laboratory medicine in a community hospital setting. And in so doing, my hope is to initiate a conversation about what we must learn, re-learn, or create in order to continue to provide patients, our physician colleagues, and hospital systems with relevant diagnostic and disease management information and guidance, which is the founding mission of our specialty and is our calling as physicians.
Thanks Dad for your prophetic advice, so long ago – this blog is dedicated to you, and to all of “the greatest generation” of primary care pathologists. May we fan the flame of the torch and bear it well into the future.
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