Are pathologists becoming mere technicians?

a Nichols L. Are pathologists becoming mere technicians? [editorial]. How many hours each workday do you spend interacting with a computer screen instead of a person? As a pathologist, if you are signing out digital slides, flow cytometry or molecular diagnostic tests, interacting with a computer screen instead of a human being probably takes up most of your workday. Looking at glass slides is also usually without interpersonal interaction. Now ask yourself: of the diseases you are diagnosing, how much knowledge of their clinical manifestations (such as signs and symptoms) are you using to diagnose them? You do need years of training in morphology and the technical aspects of pathology to make the diagnoses that you make. The technical knowledge that you need of immunohistochemical, flow cytometric and other types of patterns continues to grow by leaps and bounds. For example, years ago, a lung biopsy showing adenocarcinoma would be signed out using only routine hematoxylin and eosin (H&E) staining, but now it increasingly requires immunostaining to confirm that it is lung primary and molecular testing for mutations conferring sensitivity to targeted therapy. Pathology journals are filled with pattern recognition technical information. Routine H&E morphology is a rapidly decreasing part of most pathology journal articles, and often it is absent altogether. Gross pathology is rarely discussed and the working knowledge of it required for surgical pathology specimen processing has largely passed from pathologists to pathology assistants. Pathologists' knowledge of how the gross and microscopic pathology relate to the signs, symptoms and other clinical manifestations of diseases is fading. Under relentless pressure to simply make more diagnoses and the necessity of escalating technical knowledge to make those diagnoses, pathologists are increasingly becoming pattern recognition specialists, and are losing touch with most of the clinical aspects of the diseases they are diagnosing. As pathologists retreat into their laboratories with their computers to make diagnoses without reference to the clinical manifestations of the diseases they diagnose, they become technicians. They remain highly trained experts, but function as mere technicians, who do not use their knowledge of clinical medicine to do their work. Under these circumstances, it is only a matter of time before economic forces drive their replacement by technicians, who do not have training in clinical medicine. Such technicians would be easier to produce, and-no doubt-cheaper to employ. If the diagnoses of non-physician technicians are as correct as those of physician pathologists, …