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Gutmann EJ. Pathologist-Patient Visits-Revisited. Am J Surg Pathol 2022; 46:e94-e96. [PMID: 35220353 DOI: 10.1097/pas.0000000000001877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Direct pathologist-patient encounters are infrequent, but there has been a modest movement toward such interactions in the past 2 decades. The present article places that movement in perspective. It includes a discussion of diverse factors-including congressional laws, the views of department chairs, and progress in artificial intelligence-that could promote pathologist-patient interactions and also reviews factors that might deter such encounters.
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Affiliation(s)
- Edward J Gutmann
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon
- Dartmouth (Geisel) School of Medicine, Hanover, NH
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2
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Johnson KM, Esselmann J, Purdy AC, Jorns JM. Patient Use of Pathology Reports via Online Portals. Arch Pathol Lab Med 2022; 146:1053-1055. [PMID: 35802939 DOI: 10.5858/arpa.2021-0579-ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Kimberly M Johnson
- From the Department of Pathology, Penrose-St Francis Health Services, Colorado Springs, Colorado (Johnson)
| | - Jennifer Esselmann
- From the Department of Oncology (Esselmann), the Medical College of Wisconsin, Milwaukee
| | - Anna C Purdy
- From the Department of Surgery (Purdy), the Medical College of Wisconsin, Milwaukee
| | - Julie M Jorns
- From the Department of Pathology (Jorns), the Medical College of Wisconsin, Milwaukee
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3
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Lapedis CJ, Kroll-Wheeler L, DeJonckheere M, Johnston D, Owens SR. Broadening the Scope: A Qualitative Study of Pathologists' Attitudes Toward Patient-Pathologist Interactions. Am J Clin Pathol 2021; 156:969-979. [PMID: 33948623 DOI: 10.1093/ajcp/aqab044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study qualitatively explored and described pathologists' attitudes toward patient interaction. METHODS In a survey to pathologists, we asked, "How interested would you be in meeting with patients to discuss their pathology report and show them microscopic images of their tissue?" Then, we asked "Why," followed by a free-text box. We asked pathologists to assume that their time would be adequately compensated and that patients' treating clinicians had already told them their diagnosis. Physician age, gender, rank, and type of practice were also collected. RESULTS We surveyed 197 pathologists, 86% of whom were either definitely interested or interested in meeting with patients. Interest level did not differ by age, gender, or rank but was higher in academic practices than in community practices. Thematic analysis showed that pathologists believed that meeting with patients could impact (1) patients, through cognitive and emotional pathways; (2) pathologists, through patient contact and job satisfaction; and (3) the field of pathology, through quality of care and a redefined image of the specialty. CONCLUSIONS Pathologists' interest level in meeting with patients was high. Potential impacts on patients, pathologists, and the field of pathology were identified.
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4
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Joseph L. Your Doctor, the Pathologist, Will See You Now. Am J Clin Pathol 2021; 156:939-940. [PMID: 34549266 DOI: 10.1093/ajcp/aqab040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lija Joseph
- Department of Pathology, Lowell General Hospital, Lowell, MA, USA
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5
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Jug R, Booth AL, Buckley AF, Newell J, Kesterson J, Gardner JM, Ozcan L, Liu B, Green CL, Joseph L, Cummings TJ. Multisite Quality Improvement Study of a Patient-Pathologist Consultation Program. Am J Clin Pathol 2021; 155:887-894. [PMID: 33367493 DOI: 10.1093/ajcp/aqaa202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this multisite quality improvement study was to evaluate patients' experiences with the patient-centered pathology (PCP) consultation program and to determine whether PCP enhanced their care experience. METHODS Patients were invited to attend PCP consultations to review their pathology report and slides and have their questions answered by the pathologist privately, with the option to attend the appointment with family members or friends for support. A patient experience questionnaire (PEQ) was administered to patients, who participated voluntarily in the PCP, and survey data were collected and stored in REDCap. Statistical analysis was performed using SAS 9.4 (SAS Institute). RESULTS Sixty-seven patients (95.5% female) aged 18 to 84 years across 4 institutions completed the PEQ. Overall, 58% and 15.8% of patients had breast and brain tumors, respectively, and 59.7% of tumors were newly diagnosed. Most patients thought it was important for them to learn as much as they could about their health condition. However, the majority of patients reported some degree of difficulty learning about their health condition based on written information, despite 97% having completed high school and/or further education. The majority of patients rated their pathologist as "excellent" across communication metrics. Ultimately, 100% of respondents were satisfied, found their visits to be useful, and would recommend the PCP to other patients. CONCLUSIONS Patients found that personalized clinical encounters with pathologists improved their understanding of their health condition and their satisfaction with their care experience. Patients thought pathologists communicated respectfully, effectively, and empathetically.
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Affiliation(s)
| | - Adam L Booth
- Department of Pathology, University of Texas Medical Branch at Galveston
| | | | | | - Joshua Kesterson
- Gynecologic Oncology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey
| | - Jerad M Gardner
- Department of Laboratory Medicine, Geisinger Medical Center, Danville, PA
| | | | - Beiyu Liu
- Biostatistics and Bioinformatics, Duke Health, Durham, NC
| | | | - Lija Joseph
- Pathology, Lowell General Hospital, Lowell, MA
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6
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Shachar E, P Hasson S, Fayngor R, Wolf I, Hershkovitz D. Pathology Consultation Clinic for Patients With Cancer: Meeting the Clinician Behind the Microscope. JCO Oncol Pract 2021; 17:e1559-e1566. [PMID: 33797957 DOI: 10.1200/op.20.00948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Traditionally, pathologists have been branded the doctor's doctor, with a position behind the microscope and limited interaction among patients, despite their rich understanding of disease development and ability to navigate personalized medicine in an era of dynamic molecular testing. METHODS We piloted a unique patient-pathology consultation service, whereby pathologists review tissue specimens with oncology patients, facilitating a platform for heightening patient understanding of their disease and guiding additional genetic and molecular evaluation. We conducted a retrospective survey assessing patient experience. RESULTS Fifty-nine patients participated in the patient-pathology clinic consultation, with a median age of 64 years and a female predominance (33, 55.9%). The majority of patients were treated for sarcomas (11, 18.6%), breast cancer (10, 17%), and GI tumors (10, 17%). Half of the participants consulted regarding a metastatic disease (28, 47.5%). Thirty patients (50.8%) were referred to additional workup, 11 patients (18.6%) to a second opinion, and 25 participants (42.4%) were counseled to complete genetic sequencing or additional molecular profiles on their pathologic samples. Twelve patients (20.3%) were referred for pathology revision within our institution. Three patients (5.1%) had a change in treatment plan resulting from the clinic visit. The majority (90%) would recommend the patient-pathology clinic to other oncology patients. CONCLUSION To our knowledge, this is the largest study of patient-pathologist consultation services implemented at a single institution. Our work suggests that the program may provide effective patient understanding and reinforce the role of the pathologist as the patient's doctor. This work surfaced the concerns of patients, regarding their pathology reports, and demonstrated that the patient-pathology clinics are a valuable platform to address patients' distress regarding uncertainty of their diagnosis and an integral resource engaging directly with patients, driving additional evaluation and patient-targeted treatment.
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Affiliation(s)
- Eliya Shachar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shira P Hasson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Rochelle Fayngor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dov Hershkovitz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Kunc M, Miszewski K, Bieńkowski M, Kamieniecki A, Ekman M, Gorczyński A, Biernat W. Who Is a Pathologist According to Oncology Patients and Internet Users? A Survey Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:370-376. [PMID: 31667680 PMCID: PMC7994219 DOI: 10.1007/s13187-019-01640-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The pathologist is frequently called "the doctor's doctor." However, there are many uncertainties about the role of a pathologist among patients and policymakers and even among other medical specialties. The aim of the current study is to analyze the misconceptions of who a pathologist is among inpatients and Internet users, to find where the lack of understanding is originating from, and to confirm the need to educate the general public about pathologists. The survey of Internet users was conducted among Facebook users, utilizing the snowball sampling method. Inpatients were randomly recruited in the Department of Surgical Oncology. Seventy-eight inpatients and 320 Internet users were enrolled in the study. Significantly, more hospital patients than Internet users answered that the pathologist is not an MD (p = 0.00953). A portion of participants stated that pathologists do not make diagnoses (n = 28, 7.03%) and do not influence the treatment plan (n = 37, 9.30%) and that the other specialists do not gain anything from the pathologist's work (n = 67, 16.83%). Only 15.07% of respondents had their information about pathologists from other doctors. The findings from this study should show that even the most basic knowledge of a pathologist being an MD is not known. Pathologists are not recognized for being involved in the diagnosis of diseases. This should provide an incentive to pathologists to teach future doctors, policymakers, and patients about the perplexity of the pathology specialty. It shows obvious gaps in the knowledge of the treatment process as a whole.
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Affiliation(s)
- Michał Kunc
- Department of Pathology, Medical University of Gdańsk, Mariana Smoluchowskiego 17, 80-214, Gdańsk, Poland.
| | - Kevin Miszewski
- Student Scientific Circle of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Bieńkowski
- Department of Pathology, Medical University of Gdańsk, Mariana Smoluchowskiego 17, 80-214, Gdańsk, Poland
| | - Alexandra Kamieniecki
- Student Scientific Circle of Pathomorphology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Ekman
- Department of Surgical Oncology, Medical University of Gdańsk, Gdańsk, Poland
| | - Adam Gorczyński
- Department of Pathology, Medical University of Gdańsk, Mariana Smoluchowskiego 17, 80-214, Gdańsk, Poland
| | - Wojciech Biernat
- Department of Pathology, Medical University of Gdańsk, Mariana Smoluchowskiego 17, 80-214, Gdańsk, Poland
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Harrold IM, Bean SM, Williams NC. Emerging From the Basement: The Visible Pathologist. Arch Pathol Lab Med 2020; 143:917-918. [PMID: 31339753 DOI: 10.5858/arpa.2019-0020-ed] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ian M Harrold
- From the Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey (Drs Harrold and Williams); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Bean)
| | - Sarah M Bean
- From the Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey (Drs Harrold and Williams); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Bean)
| | - Nicole C Williams
- From the Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey (Drs Harrold and Williams); and the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Dr Bean)
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9
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Church DL, Naugler C. Essential role of laboratory physicians in transformation of laboratory practice and management to a value-based patient-centric model. Crit Rev Clin Lab Sci 2020; 57:323-344. [PMID: 32180485 DOI: 10.1080/10408363.2020.1720591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The laboratory is a vital part of the continuum of patient care. In fact, there are few programs in the healthcare system that do not rely on ready access and availability of complex diagnostic laboratory services. The existing transactional model of laboratory "medical practice" will not be able to meet the needs of the healthcare system as it rapidly shifts toward value-based care and precision medicine, which demands that practice be based on total system indicators, clinical effectiveness, and patient outcomes. Laboratory "value" will no longer be focused primarily on internal testing quality and efficiencies but rather on the relative cost of diagnostic testing compared to direct improvement in clinical and system outcomes. The medical laboratory as a "business" focused on operational efficiency and cost-controls must transform to become an essential clinical service that is a tightly integrated equal partner in direct patient care. We would argue that this paradigm shift would not be necessary if laboratory services had remained a "patient-centric" medical practice throughout the last few decades. This review is focused on the essential role of laboratory physicians in transforming laboratory practice and management to a value-based patient-centric model. Value-based practice is necessary not only to meet the challenges of the new precision medicine world order but also to bring about sustainable healthcare service delivery.
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Affiliation(s)
- Deirdre L Church
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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Lapedis CJ, Horowitz JK, Brown L, Tolle BE, Smith LB, Owens SR. The Patient-Pathologist Consultation Program: A Mixed-Methods Study of Interest and Motivations in Cancer Patients. Arch Pathol Lab Med 2019; 144:490-496. [DOI: 10.5858/arpa.2019-0105-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
There is a wide disconnect between patients and the pathologists who make their diagnoses. Recent literature highlights successful programs in which patients meet with pathologists to review their pathology reports and see their tissue under a microscope. We do not know how many patients are interested in such a service, nor do we understand what drives interested patients to want to meet with their pathologist and what specific value it may provide.
Objective.—
To quantify patient interest in a patient-pathologist consultation program and qualitatively assess motivations for patient interest or disinterest.
Design.—
Subjects were recruited from an academic cancer center and a local community cancer support group to respond to a survey about their interest in a patient-pathologist consultation program. Both online forms and paper surveys were available. The online survey was promoted via social media.
Results.—
There was a high level of patient interest, with 75% of respondents indicating they were definitely interested in a patient-pathologist consultation program. Key themes of interest were enhanced understanding of the diagnosis and disease, an opportunity to demystify the diagnostic process, and the perception that additional knowledge would empower the patient.
Conclusions.—
In a select group of cancer patients, there is a very high level of interest in a patient-pathologist consultation program. Pathologists, clinicians, and hospital leadership should work together to pilot these programs in diverse settings. Additional quantitative work to scale interventions for the interested population and qualitative work to design effective, patient-centered consultation programs and to assess value are needed.
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Affiliation(s)
- Cathryn J. Lapedis
- From the Department of Veterans Affairs, Ann Arbor Health System, Ann Arbor, Michigan (Dr Lapedis); the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (Dr Lapedis and Ms Horowitz); and the Division of Quality and Health Improvement (Ms Brown, Mr Tolle, and Dr Owens) in the Department of Pathology & Clinical Labs (Drs Lapedis, Smith, and Owens, Ms Brown, and Mr T
| | - Jennifer K. Horowitz
- From the Department of Veterans Affairs, Ann Arbor Health System, Ann Arbor, Michigan (Dr Lapedis); the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (Dr Lapedis and Ms Horowitz); and the Division of Quality and Health Improvement (Ms Brown, Mr Tolle, and Dr Owens) in the Department of Pathology & Clinical Labs (Drs Lapedis, Smith, and Owens, Ms Brown, and Mr T
| | | | - Brian E. Tolle
- From the Department of Veterans Affairs, Ann Arbor Health System, Ann Arbor, Michigan (Dr Lapedis); the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (Dr Lapedis and Ms Horowitz); and the Division of Quality and Health Improvement (Ms Brown, Mr Tolle, and Dr Owens) in the Department of Pathology & Clinical Labs (Drs Lapedis, Smith, and Owens, Ms Brown, and Mr T
| | - Lauren B. Smith
- From the Department of Veterans Affairs, Ann Arbor Health System, Ann Arbor, Michigan (Dr Lapedis); the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (Dr Lapedis and Ms Horowitz); and the Division of Quality and Health Improvement (Ms Brown, Mr Tolle, and Dr Owens) in the Department of Pathology & Clinical Labs (Drs Lapedis, Smith, and Owens, Ms Brown, and Mr T
| | - Scott R. Owens
- From the Department of Veterans Affairs, Ann Arbor Health System, Ann Arbor, Michigan (Dr Lapedis); the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (Dr Lapedis and Ms Horowitz); and the Division of Quality and Health Improvement (Ms Brown, Mr Tolle, and Dr Owens) in the Department of Pathology & Clinical Labs (Drs Lapedis, Smith, and Owens, Ms Brown, and Mr T
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