Appending a List of Consultants to Surgical Pathology Reports

In a recent guest blog, Dr. Alexis Carter discussed the importance of formally documenting the names of pathology consultants on surgical pathology reports (see: Displaying Pathology Consultants' Names and Opinions in Surgical Pathology Reports). Two comments were received with reference to it. The first was from Infopathic:

Nice commentary on a rather simple concern, for which I believe has no simple solution. I would very much like to hear other voices weigh in with approaches to formally index consultations within AP-LIS solutions.

The second from, Michael Mihalik of Pathview Systems, stated the following:

We just recently had a very similar topic arise during the installation of our latest client. Our solution was an enhancement to our system which allows for both directed, formally entered consultations as well as 'hallway' consultations. A significant portion of the pathologists wanted to continue the time honored practice of noting quick agreement or disagreement, while other pathologists wanted to formally enter their own ideas in the system. Our system now accommodates both types of entry, with the formal consultation remarks only a click away in an inquiry display, but NOT on patient reports.

Both of these comments are interesting. In the light of Infopathic's comment and taking into account Dr. Carter's ideas from the blog note, I have been thinking about the idea of optionally appending an index of consultants to a surgical pathology report. This would be an optional feature. Having been consulted on a case, it would be the responsibility of the consultants themselves to personally access the case on-line, append an electronic signature into the consultant index, and also include documentation of which slide(s) were reviewed or which fields in the case of whole slide images.

I suspect that such a formal approach might run counter to the current style of "hallway consultations" with the associates in a group. In such a setting, the consultant may not always know the name of the patient in question or which particular slides were reviewed. In order for this consultant index feature to be utilized, a pathology group would probably need to convene a formal group session once or twice a day around a multi-headed scope and show the most challenging cases to each other. Such an environment would be conducive to documentation of the names of participating consultants on any particular case. I am sure that such a conference is the norm for many groups.

Michael Mihalik's comment is also interesting. For what reason would the primary pathologist not want the names of consultants displayed in the patient report but available by computer query? I suppose there are occasions when the primary pathologist would not want to emphasize the fact that several colleagues were consulted about a particular case via the patient report. This could undermine the confidence among hospital physicians about a particular pathologist if many of his or her cases required additional consultation. This could be the rationale for continuing with undocumented "hallway" conversations (i.e., "the time honored practice of noting quick agreement or disagreement"). Perhaps readers of this blog have other ideas about this point.

Comments

[Michael Mihalik]

At the risk of displaying my ignorance to the world, why WOULD a pathologist want to note the consulting pathologist on a report?

We obviously support this functionality, but I have always had this question.

I guess I have two general thoughts on the matter. The first is that is this not equivalent to the documentation of QC on a report? Obviously, I would not send out a diagnosis or result without QC being adequate. If I wanted further consultation on a case, that is my choice as the signing pathologist and would it not be customary for the requesting clinician to expect that such consultation would have occurred if there were any doubt. Document it 'yes', but put it on the report, 'why'.

My second thought about this practice is that it becomes yet one more item on a patient report, that is perhaps not particulary relevent to patient treatment. Imagine a report with a gross, microscopic, and diagnosis sections. Add an organ map, and perhaps a slide image or two. Finally, add a synoptic result section and a textual diagnosis as well. I have even gotten wind via the HL7 comittees that a 'summary' section to a report might be in the offing. With all that data on a report, it's no wonder that I've had practicing pathologists approach me with the issue of 'having difficulties with physicians reading my reports and understanding the diagnosis to act on'.

To summarize, adding some notation that another pathologist was consulted on the report can often serve just to complicate the reading of the report.

If anyone has other thoughts, I'd enjoy hearing another perspective. I am not a doctor and it would not surprise me that there is some perspective that I am missing.