It is illuminating to read the Susan Komen Foundation web site regarding pathologists and the treatment of breast cancer specimens. They also have a white paper titled, "Why Current Breast Pathology Practices Must Be Evaluated" (!). Yes, other people do pay careful attention to what we produce and it would serve us well to be aware of how we and what we do are being perceived.
The white paper raises several pertinent questions and is worthwhile to read. The major issue raised regards accuracy of diagnosis. One "sensitive" issue specifically regards the role of second opinions for the diagnosis of breast cancer. The paper raises the issue of whether "appropriate patients" (left to be determined is which patients are appropriate) should be encouraged or mandated to have a second opinion from a "breast pathology specialist." As a Board-certified general surgical pathologist, my antennae go up at this. First, there is nothing that really certifies a person as such a "specialist"--even with a "fellowship." As the paper points out, there is no curriculum or certification even for residency training. Second, breast pathology "experts" are recognized as such by peers who read the papers, listen to the lectures, and send/receive consultations to such persons. This process seems to work well despite the literature showing wide variation (not necessarily diagnostic "errors") even amongst so-called experts. The diagnostic situations referred to in the paper are exactly those types of cases where there is uncertainty/variation even amongst experts and I think it wrong to automatically assume that the generalist has it wrong when one "expert" pronounces it something else. This really undermines those of us making diagnoses in 80% to 85% (or more) all cancer patients in the U.S.
This is a long paper and I'll return to it in a later post.