A few months ago, I received an email from a newly-minted pathologist/reader of this blog who was having an existential moment of angst questioning when the anxiety of making accurate diagnoses (day after day) goes away. Hopefully, others recently out of practice (or not) may find this helpful or provocative of one's own reflection. Below is my (slightly edited) response:
I have been in practice for 16 years now (yikes!). I still feel challenged and humbled by doing this. Why? Shouldn't I know what I'm doing by now? Complacency is a stalking evil that can happen to a pathologist, or any physician for that matter. I still feel "anxious" about accurately diagnosing every case mostly because I know that someone and their family are anxiously waiting for a diagnosis. But this is a good thing--we need that edge, we need to bring our "A" game to the table every day and with every case. The "secret" is what you do with the challenge and the anxiety that comes with people putting their health in your hands.Since we pathologists do not see patients, I have to make a personal connection with each case and "encounter" that slide as I would a patient in front of me. Part of this is my way of compensating for something that I miss and what I feel is one of the least attractive things about our field--the lack of patient contact. And part of this is to remind myself to focus all my attention on this particular case. This forces me to take one slide, one patient at a time, instead of getting uptight about the pile of slide-trays that I have to get through before that QA meeting or struggling over a difficult case when I've got 25 more cases to finish or flying through mundane cases and possibly missing something significant. Not good. In a broader sense, this is my way of embracing the complexity and mystery and glory of life--and acknowledging my limitations in understanding even a small part of it. This is part of my recognition of my own limitations--the humility before the incredible diversity and complexity of human life and disease. It is like trying to appreciate not only the beauty of the forest but the intricate beauty in the pattern of each leaf, and the warp-and-weave, ebb-and-flow of biochemical changes occurring in every cell. I suppose this sounds highfalutin. But I do believe that approaching each day anew, each case anew, each slide anew keeps me open to creative solutions to difficult cases and appreciative the uniqueness of the commonplace.I confess going through my own adversity a few years ago--a period of profound crisis. I never felt so alone in my life. In retrospect, this helped me re-focus and re-prioritize in order to survive and continue doing this at a high level. After a great deal of prayer, reflection, forgiveness, and discernment, I determined that I had to carry on. I asked myself: what was the best period of my professional career? What made me excited about pathology? Well, after consideration, I realized that it was when I was a medical student and then pathology resident. Every day was filled with new things--it was fresh and exciting to learn all this new stuff and be increasingly responsible for patient care. So I decided to put myself mentally back in that same mind-set: that I know nothing and have so much to learn and must approach each case, each day as a new opportunity to learn.Of course, I struggle with cases. But now, instead always insisting on being "right," I try to appreciate each case in its own "uniqueness" and spending time, even if it is a few extra seconds, to appreciate the epithelial lining of the vas deferens or the -itis in the appendicitis. While many common things look similar from afar or in haste, I find that looking at every case as if you've never seen anything like it before is exciting and liberating. Sometimes I gush about cases like a first-year resident and I'm sure that my colleagues snicker behind my back as they pretend to have seen it before--but that's cool with me, that is exactly the "sweet spot" I'm aiming for!If you enjoy what you are doing as a pathologist, then embrace that passion and go with it! I see so many pathologists, other physicians, med techs that would rather be anywhere else than at work. Sad, so sad. You should first allow yourself to enjoy WHAT you are doing instead of fussing about the OUTPUT (number of cases signed out, CPT codes, malpractice, reimbursement, etc.). In this way, you will not only continue to grow in your field, but you will also develop a keener sense of your limitations and know when it is appropriate to ask for help. The "output" things are certainly important, of course, but they must be rightly ordered. Paradoxically, you will find that you are making "better" diagnoses and have a more nuanced approach to cases. And never stop trying to learn everything you can!
The only thing that I can add (and this is big) is to acknowledge the profound Catholic religious impulse that animates my work and impels my practice of medicine. Ultimately, I do this for the love of God. I leave it at that for now but perhaps another time, another post.
Thanks so much for your comments! Shannon, I agree and believe that work can be a form of worship--no matter what that work is. The tendency--by both employers and the employed--to separate work from "family" (i.e., our personal or home life) appears detrimental to both. This leads to a dis-integration on so many levels. Pope John Paul II wrote so beautifully about the integration and spirituality of work in "Laborem Exercens."
Posted by: Mark D. Pool, M.D. | November 23, 2010 at 10:10 PM
Mark, Thank you for such a thoughtful and delightful post. I recently had this same conversation with my pastor! I believe, when rightly ordered, our work can be a form worship. I appreciate the time you dedicate to this blog, and to the overall practice of pathology. --Shannon
Posted by: Account Deleted | November 23, 2010 at 11:27 AM
As I follow your blog "religiously", I was delighted to read todays reflections. You are articulating beautifully the enjoyment of practicing our profession. Additional satisfaction comes, away from the inherent pressures, from releasing in timely manner the final report. As you say, always hoping and praying that is accurate and helpful to our patients. Thanks for your insights.
Posted by: michael constantinescu | November 19, 2010 at 09:31 AM