Integration of Anatomic and Clinical Pathology

Although I have posted a number of previous notes about the potential merger of pathology and lab medicine with radiology, I strongly believe that such a change must be preceded by a much tighter integration of clinical pathology (CP) and anatomic pathology (AP). Part of the value of the proposed merger for radiologists will be the ready availability of a total view of disease based on both molecular diagnostics and morphologic observations coming from the pathologists.

As I have noted before, one of the key practice models for this future direction for CP and AP will be the practice of hematopathology in which both the morphologic characteristics of malignant cells as well as their biochemical nature are taken into consideration when arriving at a diagnosis (see: Reinventing Pathology: The Hematopathologist as a Model for the Pathologist of the Future). In addition, hematopatholgists frequently participate in the selection of therapy for patients because such choices are frequently based on their diagnoses and thought processes.

There is growing evidence that the practice of surgical pathology is now moving closer to clinical pathology. Evidence for this can be found in the lectures of Dr. Jeff Myers. He has emphasized the close collaboration of surgical pathologists with pathology informaticians to increase patient safety (see: Aligning Surgical Pathology & Aligning Surgical Pathology & Informatics to Promote Informatics to Promote Patient Safety). Research in tissue biomarkers will also help to convert surgical pathology to a more quantitative discipline (see: In-Vitro Biomarkers vs. In-Situ Biomarkers; Changing Strategies for Interrogating Tissue Samples: A Systems Pathology Primer).

In my past blog notes and in the interest of being all inclusive, I have found myself using the awkward phrase pathology and laboratory medicine to refer to the field. This is truly a mouthful but I can't come up with the better name for the more closely merged CP-AP unit that I am discussing here. Therefore, I have decided to refer to it in the future as PLM. I know that change is merely cosmetic but having a more manageable name will be useful. If and when PLM merges with radiology, this problem will go away. We can then refer to the merged entity as diagnostic medicine.

Comments

[bev M.D.]

I agree with you entirely, that AP and CP, once so far apart the same people didn't want to practice both, will eventually become indistinguishable. The problem I see is the risk that the entire specialty will become commoditized as routine laboratory tests are now - and payors will not want to reimburse at M.D. levels, but rather technician levels. This may be far in the future, but the day will come in my opinion.