Surgeons I Have Known
Pathologist’s original relationship – our work partner, if you will – is the surgeon. There are just as many caricatures of surgeons as there are of pathologists, and I’m here to tell you they’re all true.
Just kidding. Were you imagining an arrogant old white man? The truth is that surgeons are diverse, remarkably brave and necessarily skilled. There is some arrogance but I think that to do such invasive tasks requires a bit of arrogance. Heck, being decisive requires a lot of confidence, and that can grow into arrogance.
Those whose arrogance is their main feature are called cowboys. And surgical cowboys usually work best with their equivalent cowboy pathologist, of which there are many. A cowboy pathologist is most likely a general surgical pathologist who has trained and matured with the surgical team at his hospital.
The term 'cowboy' in medicine has pejorative undertones, but there is grudging respect – the lone MD, doing what is necessary without beating around the bush or hedging a diagnosis. He (and it’s always a he) will tell you like it is without waffling. Not that some female physicians aren’t also cowboys. They’re just called ... something different. To be a good surgical pathologist you have to sometimes put on a cowboy hat, or as a female colleague told me, put on your big girl panties.
This means that when you call into a surgical suite over the loudspeaker, you’ve got to speak with authority. You state your name ("This is Dr. Martin, with pathology"), the patient and the site, specifically highlighting whether it’s right or left. The surgeon wants to hear the pertinent findings, no qualifications or fudging. “The right breast is negative for tumor. … Your margins are positive at the anterior aspect. … The brain smear shows reactive astrocytes – no tumor.”
A surgical pathologist from my residency program at the world famous medical clinic had a plaque outside the lab emblazoned with his face in bas relief. The quote was: Rarely Wrong, Never in Doubt. That was the quote of a cowboy.
I myself have struggled with the opposite problem - the imposter. Overqualified but never enough. I've had to really put up my best defenses when at work, toughening up in the wild west.
Pathology residency is dominated by Surgical Pathology which means lots of time in and around the OR. After my basic training I went on to do a fellowship in Dermatopathology. My primary work partners now are Dermatologists, and what makes my field unique is the communication and collaboration with Dermatologists and Pathologists. During my fellowship, I studied Clinical Dermatology while Dermatologists studied Dermatopathology. There was lots of overlap, peer to peer teaching and different ways of learning all crammed into one year. Dermatopathologists like to look at the clinical photos and read the chart (especially for rashes!). There is a long tradition of communication which helps us reach the most accurate diagnosis.
In general Pathologists really know your doctors and surgeons. We know who does the most accurate lumpectomies, whose surgeries will take the longest, who gets the most productive aspirations. We know the individual surgeons at our hospitals and we also have a feel for each 'type' in each specialty, which could make for an interesting post. I tell people - ask your local pathologist to recommend a surgeon!
Now I predominately interact with surgeons when I am covering the Frozen Section lab, the place for immediate results from the OR. And it turns out, I really like surgeons. Maybe I'm more confident, or maybe in private practice on a Saturday night their questions are often simpler than in training - what is it, and did I get it all out? I appreciate directness and that's what you get from the OR.
We make a good team, surgeons and pathologists - we've both got our hands on your insides, and both of us know literally what the shape of your disease looks like.