The pathologist in the 21st century--generalist or specialist?

Abstract

A jack of all trades and master of none?Virchow and his fellow pioneers were active in the 19th century, but pathologists are largely a creation of the 20th century and have really only been present in numbers in the second half of the century. In the United Kingdom the development of the National Health Service over this period has seen the development and expansion of hospital laboratories. This development process has been one of successive waves of specialisation.The first consultant that I worked for had started his consultant career as a single handed general pathologist, covering all aspects of pathology in what was, for the time, quite a large district hospital. He began with a skeleton staV and by the time of his retirement was working in a laboratory that had expanded to have consultants in histopathology, haematology, and microbiology, and a senior biochemist in the chemical pathology department. In the ensuing years that laboratory has closed as a result of rationalisation and amalgamation of services. The histopathology and cytopathology services are now provided as part of the work of a larger group of consultants whose work comes from several hospitals and who are each specialised, working only in one or a small group of subspecialist areas.The move from generalist to specialist has been far quicker in the clinical specialties, which were fewer in number 50 years ago. The general surgeon and the general physician held sway in the general hospital.

Histopathology training in Europe: a lesson for other specialties?

“…As the Belgian government recently even decided to decrease histopathology positions, it should be strongly advised to adopt the policy of the EU nations in order to prevent irreparable damage to the clinical services and patients relying on expert histopathology. The laboriousness and complexity of the histopathologist's work have increased based on the new diagnostic and therapeutic options in cancer, leading to more refined and individually tailored clinically relevant questions, mandatory regulations for documentation and registration of case data and material and the increase in cancer patients due to ageing of the population [2,7]. In addition, strict quality control measures have to be followed in histopathology services to minimise the risk of misdiagnosis and patient harm, further intensifying the professional burden.…”

“…This requires reflection on the primary tasks of histopathology, its future professional and technical developments, its relationship with other clinical [8] and laboratory-oriented specialties [1] and its communication with the public [4]. Currently, discussions on these issues are being held in the UK [9] and among surgical pathologists in the USA [1,7]. They both illustrate the need to reassess the status of histopathology in the EU in order to guarantee sufficient capacity and quality in clinical services to patients.…”

Can the Leibovich score for clear cell renal cell carcinoma (ccRCC) be accurately reported by a general pathologist?

“…Multiple studies have shown discrepancy rates between original and review histopathological diagnoses of up to 30% with a mean of ≈10% . Sub‐specialisation within pathology is associated with higher standards of diagnosis and reporting .…”

Microbiology

“…With the help of many people, we have filled this issue with some reflections by our editors on papers from the first issue of JCP in 1947, 1-5 together with some visionary papers on developments in pathology. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] We are indebted to all those who have contributed to this issue and extend our thanks to them. …”