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Pathology: A Career in Medicine Brochure

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Donna Stivers
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The Pathologist in Patient Care

The pathologist uses diagnostic and screening tests to identify and interpret the changes that characterize different diseases in the cells, tissues, and fluids of the body. Anatomic pathology involves the analysis of the gross and microscopic structural changes caused by disease in tissues and cells removed during biopsy procedures, in surgery, or at autopsy. Cytopathology, the examination of individual cells to aid in disease detection, is an important component of modern patient care. Clinical pathology encompasses chemistry, microbiology, immunology, hematology, coagulation, and blood banking, among other types of laboratory testing. Molecular pathology utilizes strategies for DNA and RNA hybridization and amplification as well as proteomics to aid in many aspects of both clinical and anatomic diagnoses. Collectively, all the pathology specialties contribute to understanding disease and treatment of the patient.

For all pathologists -- clinical, anatomic, molecular, investigator or researcher -- better patient care is the ultimate goal. Pathologists participate in day-to-day care of patients by providing and interpreting laboratory information to help solve diagnostic problems and to monitor the effects of therapy. Because of the expanding volume of new and highly complex tests, clinicians rely on the pathologist for guidance and direction in use of the clinical laboratory and interpretation of test results. The rapidly evolving field of molecular diagnostics is driving precision medicine initiatives and involves techniques that permit identification of carriers of genetic disease, diagnosis of viral and bacterial infections, monitoring of cancer therapy, DNA fingerprinting for forensic (medico-legal) analysis, and detection of biomarkers that assist in prognosis. When unusual or unexpected abnormal results are identified, and particularly when critical or life-threatening alterations are found, the pathologist communicates directly with the patient's physician.

In addition to daily communication with other health care professionals about test results, many pathologists have direct patient contact on a frequent, and even daily, basis. It is common for the pathologist to perform a fine-needle aspiration of suspicious masses or a bone marrow aspiration or biopsy to diagnose hematologic disease. In Transfusion Medicine, the pathologist plays a pivotal role in the selection of appropriate blood product therapy and the management of transfusion reactions. One of the most direct patient management and practice roles that some pathologists perform is apheresis therapy, a process that removes pathologic substances from the blood stream. Apheresis is performed for a variety of disorders and can be immediately life-saving or used for long-term care. As a result, pathologists not only provide acute care, but also form long-term relationships with patients and their families.