Episode Transcript
Dr. Miller: What does a pathologist do, exactly, and how can they help you stay healthy? I'm Dr. Tom Miller, and we're going to talk about that next on Scope Radio.
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Dr. Miller: Hi, I'm here with Dr. Jerry Hussong, and he is a clinical pathologist and also the chief value officer for ARUP Laboratories. Jerry, aside from what we see on CSI and some of these shows on TV, what does a pathologist really do, and how does that relate to the person who is having an annual examination or seeing a physician for a particular problem?
Dr. Hussong: Everybody thinks a pathologist is a person responsible for doing an autopsy. And it's not just autopsies that the pathologist does. Really, pathology is the study of disease, of the cause of disease and the effect of disease.
Dr. Miller: And actually, autopsies are a small part of what a pathologist generally does. Is that right?
Dr. Hussong: A very small part, and that's just a small part of anatomic pathology, but there's a whole other area of pathology called clinical pathology. Pathologists are physicians who specialize in diagnosis and management of disease through laboratory test medicines.
Dr. Miller: So I can say as an internist, the assets that pathologists bring to the table are incredibly valuable, and yet a patient may never see a pathologist during the course of their treatment.
Dr. Hussong: Often, they will not see a pathologist. They may see a bill from a pathologist, and wonder why they didn't see the pathologist and what is this bill from, but it's really for producing the laboratory tests our clinical colleagues then use to treat the patients.
Dr. Miller: And so what's so important about your role is, I imagine, making sure that the test results are accurate and precise.
Dr. Hussong: So a pathologist is usually the laboratory director who is legally responsible for the quality and the accreditation of the laboratory in which the tests are going to come out of. Laboratories are regulated by state agencies, and each state has their own specific requirements for regulation. All laboratories undergo accreditation by CLIA, which is the Clinical Laboratory Amendments Act, that really oversees the quality of testing. But the pathologists make sure that those tests results are accurate, and that is how we serve patients and serve the physicians that are taking care of patients.
Dr. Miller: You know, I've always felt like the world of quality as resides in pathology is sometimes ahead of some of the other fields in medicine. I mean, the way you guys take such particular care to make sure that the results are accurate and spot-on, and that samples that go to the surgical pathologist and anatomical pathologist, you have checks and balances to make sure that diagnosis are well vetted and well carried out.
Dr. Hussong: And there is a huge amount of work that goes into validating tests before we ever bring those tests online. So we go through extensive validation, checking, there's a lot of work that goes through and into the process before we bring the test online. And then once the test is online, we have to go through a continuous ongoing review and validation that nothing is going on or wrong with the test as we continue to offer the tests clinically.
Dr. Miller: A lot of ongoing quality assessments and . . . I think your work is very concise and very precise, if I might say. And that's sometimes a little bit different than what we experience in the clinical realm in our day-to-day work with patients. So when you say tests, what kinds of tests are you talking about for the patient? Are we talking about blood tests, are we talking about tissue samples, what are we talking about?
Dr. Hussong: It can be all of those. In anatomic pathology it often is a tissue sample, so a biopsy is taken, maybe a patient is undergoing a colonoscopy and they get colonic biopsies that are then sent to the pathologist to look at and see whether there is any disease process going on or if the tissue is healthy. But it also can include a number of clinical laboratory tests, which can be evaluating blood, urine, cerebrospinal fluid, and pleural fluid, any of those types of those specimens as well.
Dr. Miller: You know, I don't think people understand, or patients necessary understand, that when we order a laboratory study, it's really up to the clinical pathologist in charge of the laboratory quality control to make sure that that test is valid and accurate.
Dr. Hussong: Absolutely, and laboratories undergo proficiency testing throughout the year where there are standards that are sent out by regulatory agencies where you actually do the test and provide the result back to the regulatory agency, and they check you in relationship to other laboratories across the country to make sure you are doing high-quality laboratory testing.
Dr. Miller: So it's almost like a patient has the safety of mind, or presence of mind, that they don't really have to worry about this. It sounds like wherever you go in the country for a laboratory study or if you're going to have a tissue sample evaluated by an anatomical pathologist, that there is quality control associated with that test, no matter whether you have it done in Florida or whether it's done in California or Arkansas or any particular state.
Dr. Hussong: Absolutely. I think the key is to make sure that the laboratory is accredited by an accrediting agency, whether that is CLIA or one other of the deemed agencies such as the American College of Pathologists.
Dr. Miller: Now, there are some large laboratory companies, I think, in the country that actually run blood samples for private physicians and they're under the same regulations. Is that true?
Dr. Hussong: The exact same regulations, and they will have a medical director who will oversee and be responsible for the laboratory testing out of that laboratory.
Dr. Miller: So mostly for patients that are listening and families that are listening, it's really peace of mind to know that we have a clinical pathologist behind the study and quality of the tests and test results.
Dr. Hussong: Absolutely, and it's important for patients and families to realize that the pathologist is a part of the health care delivery team. They may not see us, but we are going to provide useful and valuable information to the clinicians, who are then going to take that information to use and treat the patients that they are seeing.
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