Peering behind the pathology lab door: A day in the life of a pathologist

While pathologists play a vital role in a patient’s diagnosis and treatment plan, patients often don’t get the chance to meet them, making the importance of what they do something of a mystery.

So to mark National Pathology Week, we decided to sit down with Dr Suzy Lishman, President of the Royal College of Pathologists, to find out what they’re all about.

What made you decide to become a pathologist?  

President Dr Suzy Lishman, Royal College of Pathologists

As a medical student and junior doctor, I was interested in the scientific basis of disease and enjoyed the challenge of finding out why a patient was ill, how their diagnosis was made and what the most effective treatment was. And although I loved working with patients, my fascination with disease at the cellular and molecular levels led me to pathology – and I’ve never looked back.

Why is pathology so important in diagnosing cancer?

Although they rarely meet, almost all patients have their cancer diagnosed by pathologists and the earlier cancer is diagnosed, the better the outcome is likely to be.

Whenever a biopsy is taken or a tumour removed it’s a pathologist who tells the surgeon what type of cancer it is, whether the tumour has been completely removed and, increasingly, what the most effective treatment is likely to be.

Pathology also plays a key role in screening for cancer; identifying early changes in cells that indicate that cancer may develop later if left untreated.

For example, pathologists examine cervical smears to look for pre-cancerous changes, enabling women to have the abnormal cells removed before they develop into something more serious.

What’s the best part of your job?

I divide my time between two jobs: I’m both a consultant pathologist in Peterborough and the President of the Royal College of Pathologists.

As a practising pathologist I most enjoy my role as a member of several multi-disciplinary teams (MDT), where I contribute to discussions about individual patients with a team of surgeons, radiologists, oncologists, nurses and other colleagues. Between us we discuss all aspects of each patient’s care and review all the available evidence to make decisions about the best treatment or investigation to offer the patient. It’s very satisfying to learn how the diagnosis I make down the microscope contributes to care of the patient.

On the other hand, as President, my favourite part of the job is talking to members of the College around the country and finding out about their concerns and opinions, and representing them at a national and international level – to government, industry, other pathology organisations and the public.

What are the main challenges?

On a personal level, the main challenge is balancing my two jobs and my family life.

Professionally, the main challenge is that there’s insufficient investment in pathology services at a time when the volume and complexity of work is increasing rapidly and targets are being introduced to reduce turnaround times. Without reliable IT systems, modern equipment and a fully trained workforce, pathology services will not be able to keep up with demand.

What does a typical day look like?

A typical day starts at 7.30am when I catch up on any emails that have come in while I’ve been out of the department on College business.

I then start reporting cases that have been given to me – including bowel cancer screening cases and cervical smears.

After that I prepare for the MDT meeting, reviewing all the slides from cancer cases that have been diagnosed that week.

In the two-hour MDT meeting, we discuss all the patients who are being treated that week.

The surgeon might give the background to the case, the radiologist shows the scan and I’ll describe the pathology, including the presence of any markers that will help decide the best course of treatment.

There will then be a general discussion with the wider team, taking into account the patient’s wishes, their fitness, other health conditions and home circumstances. By the end of the discussion a treatment plan will have been put together for discussion with the patient by the surgeon or oncologist.

After the MDT meeting there’ll be a pile of slides on my desk waiting to be reported. These will usually include urgent cancer biopsies, which need to be reported the same day if possible.

I work with a great team and I discuss difficult or unusual cases with my colleagues at a multi-headed microscope meeting every afternoon. We all bring cases to show each other and discuss the best way to proceed with complex cases.

Finally, I usually do a ‘specimen trimming’ session in the afternoon where I examine large specimens such as colectomies (removal of part of the colon) or skin cancer excisions that have been sent to the lab for analysis. I describe the appearances of the specimen and select small pieces for examination under the microscope the following day.

If money were no object, what would you change about pathology services?

There are two things I’d like to change. First, would be to introduce a national IT system for pathology.

Cancer diagnosis increasingly involves tissue being sent from the hospital where the patient is being treated to a large centre with a molecular lab and national experts.

So having a single, connected IT system would help all the pathology labs communicate with each other, reducing unnecessary testing and ensuring treatment decisions are made with all the relevant information available. It would cover blood tests as well as cancer biopsies, so would also benefit patients with conditions such as diabetes, kidney disease or heart failure.

And having national data would allow large-scale studies to improve services for patients.

For example, if all histopathology images were digitised they could be shared electronically, reducing the time spent obtaining second opinions and creating a database of images for research, training, examinations and quality assurance.

It would also mean that results from any lab would be integrated into the patient’s record, irrespective of where the test was done. This would support the development of networks providing efficient and cost-effective care, maximising the use of limited resources while improving patient safety.

And ideally, patients would be able to access their own records, empowering them to make decisions about their healthcare.

And my second wish? I was once interviewed by a national newspaper about how realistic the television programme ‘House’ was. I remember being struck by the fact that House had access to a state-of-the-art pathology department that appeared to be there for his personal use, and had a prominent neon sign above the door in the main corridor of the hospital.

I’ve never worked in a hospital where the pathology department wasn’t hidden away, often with few signs indicating its location. So my second wish would be for all pathology departments to be in a prominent position in the hospital, so that patients and healthcare professionals can come to the department to talk to the pathologists and scientists who work there, discuss results and find out more about how the specialty contributes to everyone’s care.

This would mean that pathology would be valued for the vital contribution it makes to patient care, which hopefully would ensure appropriate investment in the people, equipment and IT infrastructure that is needed for a responsive, high quality pathology service for the benefit of patients.