"No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering, he needs technical skill, scientific knowledge, and human understanding. He who uses these with courage, with humility, and with wisdom will provide a unique service for his fellow man, and will build an enduring edifice of character within himself...¹". We feel that the most effective medical practice is "at the point of service"...medical practice focused locally [as pathologists: " point of service pathology"].

Additionally: ***OUR GOAL IS A TEAM THAT WILL PERFORM IN THE MANNER OF A LOCAL PROFESSIONAL "CALLING" RATHER THAN JUST A JOB OR BRIEF TOUR POINT IN A CAREER.

To people considering a physician career in pathology, we pathologists are able to be researchers, teachers, practitioners, or a combination of these 3 broad spheres of any medical career. In the physician specialty of Pathology and Laboratory Medicine, we are fortunate to be medical doctors (physicians) who have access to the entire breadth & depth of medical practice, both specifically with individual patients...or in general, as it relates to a medical community of varying size. A career of 30 years in pathology can easily leave one claiming to never having had a boring day in the career. We can be involved (& even in physical contact) with patients as much or as little as we like (or as the need is manifest). At the end of each practice day (if we desire to practice that way), we are able to be confident that we have made a positive difference in several to a dozen or more patient's lives. 

In chosing where to practice, teach, or research, we can testify that "things can change". Our situation is within a county converging 3 interstate highways, 4 railroad lines, and 2 public airports. The county boasts beautiful Lake Murray. Since at least 1970, it has maintained an excellently growing public school system. And the local hospital (founded in 1971 as a county hospital) is an excellent & growing health care system functioning as a county-government-associated, independent "health care district " (LCHSD). Highways, rail lines and the lake happened because of nearby Columbia, South Carolina's capitol city. Success in terms of causing outcomes in the best interests of students in schools and patients in hospitals & health care systems requires character-rich, competency-rich leadership and a surrounding community with favorable demographics (money). Our group is one component of a very strong collection of hospital-based physician groups whose inter-departmental, long-cooperative talents are the key to the original & ongoing success of the health system. Therefore, the ability of these groups to grow in a way that allows top priority focus on top quality patient care is crucial. Will the Lexington County Health Services District (LCHSD) leadership countinue the original foresight or not?

One of the more effective & positively impressive laboratory chief medical technologist we've known (Frank Defrenza) said something like, "Since they don't know what they are doing [as to in-hospital labs], you have to do what you have to do to make things work as they should". Our view is expressed more professionally & diplomatically: through local, national, and international professional organizations, through institutional and/or business/corporate hierarchy, and within physician practice groups, excellence in personal & professional character must be exerted & prevail for the sake of quality patient care. There are just too many administrative types...even physician types...in "the average system" who cannot (even though they may earnestly want to) adequately understand the medical factors and what is at stake, medically, unless we professionals can develop the relationships of trust which might lead to understanding. And, we pathologists may be greater or less than optimal in our ability to teach and persuade. Depending on the practice situation we chose (or simply land in) and our personal willingness & character, we can have from none to great degrees of impact on the quality of medical care in our variable spheres of influence. We of Pathology Associates of Lexington, P. A., find ourselves to be a mix of practitioners, teachers, and practical-applied researchers focused on the catchment area of an excellent acute care general community hospital (our group & links to CVs/resumes).

What do community-hospital pathologists do? 

• We make diagnoses (TOC) on patients from blood or bone marrow smears, from specimens removed at surgery or various biopsy procedures or from cytology preparations taken from various body sites (such as Pap smears), or from findings after death in autopsies. [The aforementioned are common to almost all community-hospital pathologists; the entirety of what follows may not apply. Or the issues may be found on a wide spectrum of "almost involvement" to "intense involvement" (our group is intensely involved).]  Some groups try to staff with specialists, some with generalists, and some (ours...a comment) with a mix...and with staffing at a proper level and with the benefit of time for annual leave to maintain continuing education and to recharge the freshness to be thorough & stay intense. Those diagnoses are rendered into an official pathology report which has many issues in mind as the report is composed [commentary about pathology reports].
• In anatomic pathology, we use technically ever-morphing basic tecniques of examining slides in a process that has advanced the practice of medicine for over 150 years. Since 1980, there have been additions of amazing ANCILLARY techniques [example = IHC] which enter practice with the promise of changing things so that diagnoses are no longer at all subjective. In a conference in early 2008, one internationally recognized expert...echoing many experts during the week, made a brief commentary about "new technology" which I am paraphrasing as a quote with which we fully agree: "Diagnosis steps warning: (1) top priority is the eyes & brain of the pathologist [the thing that insufficient staffing & helter-skelter affects most dangerously]; followed by (2) excellent fixation & good H&E; followed by (3) well done ancillary studies of all types judiciously used to test/confirm the pathologist's DDX formulated in the context of as much known clinical info as he/she can get his/her hands on (anatomic path DX without need for clin info becomes dangerous on small specimens)⁴".
• And, more globally, we medically direct the workings of the entire hospital laboratory, [as follows] and [here] . It has been pointed out that laboratorians will be held accountable for noncompliant laboratory testing in a health care entity, the JCAHO requiring a single standard of care throughout an organization³.
• For students considering a career in pathology: [ASIP] [PathNet] [APC][CAP].

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References:

1. Bryan CS, "The Seven Basic Virtues in Medicine: Summing Up", in which he quotes the opening paragraph of the first 9 editions of Harrison's Principles of Internal Medicine, J. SCMA 103 (5):135, June 2007.
2. Robbins SL (1915-2003) & Cotran RS (1932-2000), textbook of pathology, last carried on page 265 in the 3rd Edition (1984) and not as an actual quotation; in searching for whom to ascribe this quote to, I contacted Drs. W. A. Gardner @ AFIP and Dr. William H. Hartmann, retired, in June 2007; Dr. Gardner thought it might have been Dr. Fred W. Stewart (__) or Dr. Lauren V. Ackerman (1905-1993). Dr. Hartmann thought it might have been Dr. Stewart or Dr. James Ewing (1866-1943) and not what Drs. Ackerman, Cotran, Robbins, or Kumar would have said.
3. Ng VL, et. al., "POCT in the ED", ADVANCE for Medical Laboratory Professionals, p10-12, 5 November 2007.
4. Mahul Amin, MD, chair of Dept. Path. & Lab. Med. @ Cedars-Sinai Med. Ctr in Los Angeles, Calif. Co-author of current WHO manual for GU & Renal neoplasms & two AFIP fascicles & a monograph on Gleason scoring & a founding member of AJCC. He was a speaker at The Second International Course in Applied Immunohistochemistry and Molecular Pathology (Santa Barbara, Calif. 1/28/08-2/1/08).