Hi everyone,
I'm on a 2 week rotation in radiology this month. I've been sneaking in reading about bone tumors, which can be notoriously hard to differentiate histologically, and require correlation with radiology and clinical presentation to avoid misdiagnosis. Same thing with brain tumors. Sign out with the neuroradiologist has also been a wonderful review of neuroanatomy for me.
Here are some relevant sites for your perusal:
Functional Neuroanatomy from University of British Columbia. check out the movies, brain cutting
Neuroradiology cases
URochester Rads cases
U Western Ontario (more neuroanatomy)
Picked up a Neuropathology book from the Foundations in Pathology series from the library.
Also, bone tumors are interesting.
For those considering radiology, I suggest checking out these videos:
Radiology school on Youtube (bone tumors videos are esp. enticing)
Previously I pondered how one should write pathology reports.
The qualities which I feel an ideal pathology report should have are:
(1) accurate, understandable (2) readable and/or succinct, (3) useful to the clinician (4) comprehensive (synoptic when appropriate).
Observing the radiologists dictate their reports over the past two weeks, I think I've gradually come to the conclusion that, when possible, differential diagnoses should be included in more pathology reports when the findings are equivocal.
Perhaps why this is not more commonly done is because it requires a knowledge of the patient's clinical course in order to formulate. Another reason might be due to the personality of the pathologist -- I think many people go into the field because they enjoy the satisfaction of working up a case to effectively narrow a broad differential formulated by the clinican and/or radiologist and come up with a definitive diagnosis.
Certainly molecular diagnostics and immunohistochemistry can help support a diagnosis, but, especially in the field of hematopathology and cytology, so far as I've noticed, there can be multiple interpretations.
I do feel if pathologists take seriously their role as consultants that relay useful information to the clinician, it is not wrong to call or email a clinician for more clinical history/presentation to inform a differential diagnosis, and to indicate our level of suspicion for each.
Pathologists could take a page from the Radiologist's book in this regard. They are more or less experts at communicating their best educated guess and alternate possibilities to the clinician.
Another interesting reporting style which I recently noticed is: reporting comments in the format of a letter addressed to the clinician. Although I personally think this is a good way to include information to patient support groups. To me I think it should be reserved for cases in which the pathologist wishes to educate a clinician on a rare entity or condition. Personally speaking I believe all treatment/management considerations should be a decision made by the clinician and the patient, and neither the report nor the pathologist should comment.
To pathologists reading: what is your favored reporting style?
