Who is Watching?

I have seen the mistakes surgeons make. I have seen the mistakes pathologists make. They would argue I have no idea what I have seen because I only have four years of education while they have eleven or more.

It takes no degree to recognize some kinds of mistakes. For instance, a surgeon once decided to dissect a specimen in the operating room. He was playing at being a pathologist. When we got the specimen in the lab, it was impossible to tell how it fit back together. That left the pathologist with no idea of where the cancer was found, how close it was to the edge of the surgical margin, and therefor, what the prognosis might be.

The pathologist paused in his examination of the mess and looked at me. “If this doesn’t turn out well, can I rely on your loyalty?” he asked me.

What a question. He asked me if I would lie for him and the hospital. I was a witness to a tragic situation that might cause the patient undue harm. Would I be loyal. Yes, to the patient. My reply to him was, “I will be loyal to those who have earned it.”

He didn’t like that but what he didn’t know was he had earned it. He would do his utmost to diagnose the patient correctly. He would also bring that surgeon before peer review. It wouldn’t be just a hand slap. As long as the pathologist did his best to make sure such a thing like this never happened again, I would speak on his behalf. I just wouldn’t tell him as much because I didn’t want him to feel too complacent.

Histotechs see which doctors routinely fuck up. They see those who fail to get good needle biopsies. They see specimens that are inadequate or ruined. They know which doctors don’t get their work done and have to rush everything last minute. We know which ones can’t make a diagnosis.

Early in my career a pathologist told me the basic H+E stain is more than adequate to diagnose any condition. I think of that when I have to do half a dozen special stains for a pathologist to get a diagnosis. I believe that is a pathologist who can’t make up their mind. They are covering their ass with lab tests. That is not a doctor I would want diagnosing me. They are worried they will diagnose the patient’s disease wrong. They are worried their skills are inadequate and if they are worried about that, they are probably right.

Techs watch residents too. As they try to learn pathology, we can tell which ones will make it through the four years of training and which with drop out or get booted out.

At the places I have worked, many residents are from non-English speaking parts of the world. They have to learn English to study and communicate with the lab. Some don’t. They don’t last. Others panic at the work load. They don’t last either.

The arrogant resident believes techs should help them do their work or they have such a crappy attitude techs will ignore their requests just to get them in trouble. They often get set upon by their director and corrected.

A nice attitude begets a nice day. Treat techs kindly with a smile and they will likely rush the case that was forgotten, as long as it doesn’t happen too often.

A skittish, worried resident or pathologist is a warning sign to duck and hide for a tech. Such attitudes mean a lot of extra work, fixing some mishap that will be next to impossible to correct, or being asked questions we are not in a position to answer. After all, we only went to school for four years instead of eleven for a reason. It isn’t our place to diagnose or order tests. It’s our place to do the tests. And from that place, we see the best and worst of patient care.

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