A common criticism of some hospital pathologists is that they hole-up in their offices to diagnose the day's pathology slides and sometimes fail to develop meaningful relationships with hospital physicians and nurses. As an antidote to this problem, they are sometimes urged to visit the surgeon's lounge and make clinical "lab rounds" to correlate test results with clinical data. One clever pathology trainee has come up with a name for this phenomenon -- cameo appearances. I learned about this in a note posted on the Student Doctor Network (see: Pathology is the Future?). Below is the key passage:
[S]uggesting we round or otherwise make [pathologist] cameos on the floors is ridiculous. Perhaps the surgeons should spend half of their days double scoping with us too. I'm sure they have the time. Additionally, while I'm all for us in the next generation being up on the emerging technologies, this ignores the fact that we often lack the institutional and political power to effect significant change. [Only] leaders of organizations like the CAP that have this influence.
This rant was in response to a lecture by Dr. Jared Schwartz, former president of CAP, that was summarized in the following way on the same site:
[Dr. Schwartz] recommends that [pathology] residents and new graduates “lead the way” by familiarizing themselves with emerging technologies, and becoming more visible in patient care by reviewing charts, rounding with teams, and talking to patients. Seems like a lot to do while also trying to learn or practice pathology....
The problem that I have with the idea of "cameo appearances" of pathologists in clinical venues is that is overly sarcastic and snarky. It suggests that marketing would be the only reason for pathologists to leave their offices. For me, such visits should be driven by a quest for information not otherwise available on-line or to interact with clinicians and nurses to improve the quality of care. This goal is most efficiently undertaken with face-time. If written reports about the declining quality of lab services are filed in a hospital, it may be too late to correct the problem. I also have a hunch that most radiologists would laugh if it were recommended to them that they engage in cameo appearances.
As with most issues of true best practice, there optimally is an institutional zeitgeist underlying expected care. For years at our institution, pathologists are active participants in surgery, radiology and oncology conferences, not to mention multi-discipline care conferences and M&M. Moreover, with a remarkably active hospital autopsy service, we qre routinely joined by clinicians during the case. None of this behavior is cameo or marketing, but it does greatly benefit patient care and this environment of team-based practice is in fact a great positive "advertisement" for pathologists in training.
Posted by: infopathic | March 02, 2011 at 09:37 AM