In a recent article available on-line on the JAMA Network entitled Adapting to Artificial Intelligence: Radiologists and Pathologists as Information Specialists (see: Radiologists and Pathologists as Information Specialists), the authors Saurabh Jha and Eric Topol conclude that both pathologists and radiologists function as "information specialists" and therefore should consider merging their specialities. Below is an excerpt from the article:
Radiologists are more aptly considered “information specialists” specializing in medical imaging. This is similar to pathologists, who are also information specialists. Pathologists and radiologists are fundamentally similar because both extract medical information from images. Pathologists have embraced machines and technologies. Some tasks once performed manually by pathologists have been automated, such as cell counts, typing and screening of blood, and Papanicolaou tests, leaving pathologists with more complex tasks. Artificial intelligence can perform the more complex tasks of pathologists and, in some instances, with superior accuracy....Because pathology and radiology have a similar past and a common destiny, perhaps these specialties should be merged into a single entity, the “information specialist,” whose responsibility will not be so much to extract information from images and histology but to manage the information extracted by artificial intelligence in the clinical context of the patient. The information specialist would not spend time inferring conditions between competing shadows on radiographs, scroll through hundreds of images looking for pulmonary embolus on CT, or examine slides for “orphan Annie”–shaped nuclei. Artificial intelligence could perform many such tasks. The information specialist would interpret the important data, advise on the added value of another diagnostic test, such as the need for additional imaging, anatomical pathology, or a laboratory test, and integrate information to guide clinicians. Radiologists and pathologists will still be the physician’s physician. Together, the information specialist and artificial intelligence could manage individuals and populations.
Th ideas and conclusions of Jha and Topol coincide with my own, In a blog note posted here ten years ago, I called for a merger of pathology and radiology, perhaps into a new medical speciality of diagnostic medicine (see: Ten Reasons for Merging Pathology/Lab Medicine with Radiology). I have been subsequently told that the VA system merged some of their pathology and radiology departments even earlier than this, promoted by efficiency and staffing concerns. Here are more notes from Lab Soft News about this topic: More On Convergence of Pathology, Lab Medicine, and Radiology; EHRs Pose a Major Threat to Fields of Pathology & Radiology Informatics; Development of Integrated Diagnostic Servers by Pathology and Radiology. More recently, Dell Medical School in Austin had merged these two departments (see: World-Class Innovator Comes to Dell Med to Rethink Medical Diagnostics). Here is a quote from this latter article:
R. Nick Bryan, M.D. is the new director of diagnostics for the Dell Medical School at The University of Texas at Austin. He will oversee diagnostic activities for Dell Medical School, encompassing the traditional departments of radiology, pathology and laboratory medicine. Doing so will merge key components of diagnostic examinations that determine the health status of patients. Dell Med’s innovative approach will help ensure that these skills are taught and used in a more integrated way.
I suspect that if you were to ask most pathologists and radiologists to specify their primary professional task, the majority would probably choose the diagnosis of disease rather than the management of diagnostic information. One exception to this rule would be clinical pathologists who generally do not personally create most of the information from the clinical labs. The raison d'être of surgical pathologists and radiologists has thus always been the interpretation of images. Jha and Topol, however, suggest that we are now at a critical inflection point in both surgical pathology and radiology. Artificial intelligence (AI), image recognition software, and deep learning using big data (see: Allscripts Launches a Subsidiary, 2bPrecise, Focusing on Genomic Testing) have taken us to the point where most diagnostic reports will soon be generated by computers.
As an increasing number of reports are created by computers, pathologists and radiologists will begin to serve primarily as managers of information and must decide exactly which cases require human, professional intervention and interpretation. Most of us tend to view our careers and our medical specialties through the rear view mirror. More than a decade of discussion about the role of pathologists and radiologists in this information era should be sufficient to prompt a more serious discussion of what the future holds in store for medical diagnosticians. I personally believe that it lies in the creation of Departments of Diagnostic Medicine.