Practice of Pathology

Physicians that practice as pathologists are frequently described as the “Doctor’s Doctor” because, with a few important exceptions, they generally interact with a patient’s physician rather than with the patient directly. The medical practice of pathology is dedicated to the general study of disease and its processes as well as the specific diagnosis of disease, since pathologists investigate the clues to diseases and injuries through the examination of organs, tissues, body fluids, cells, and molecules.

The origins of pathology date back to the Italian Renaissance as one of the earliest examples of a scientific and empirical approach to medicine. The word derives its roots from the original Greek term for the study of pain and suffering. By the late 19th century autopsy had become a major source of medical knowledge, while researchers had begun to extend their investigations to a microscopic level. During this period, medical doctors for what later became the Department of Pathology at NYU Medical Center and NYU School of Medicine founded the very first “Pathological Laboratory” in the United States devoted to teaching and investigation in pathology in 1881.

Autopsies remain an important area of the modern practice of pathology and they are often equated in the popular imagination with it, but they form only a small aspect of the work that hospital-based pathologists do.

NYU pathologists are engaged in clinical work every day. They also participate in the training of pathology residents and fellows in clinical practice, in the education of medical students, and they supervise clinical rotations for them in the laboratory. The NYU Department of Pathology focuses on an integrative approach to the field, in which scientists and physicians strive to work in conjunction with each other to integrate the knowledge gained in research with the needs for patient care.

This kind of approach is also known as “translational” because it involves moving between the work of research laboratories and the practice of medicine. To this end, NYU pathologists publish numerous clinical papers in scientific journals on a regular basis and many of our pathologists are featured speakers at national and international meetings their respective areas of expertise. In this sense, their scientific discoveries are dedicated to the advancement of diagnostic practice.

The Work of Pathologists

Pathologists continue to lead in the investigation, identification, and understanding of disease. They do so through a close and careful examination of organs, tissues, body fluids, or cells and by studying disease processes in laboratory experiments. There are a large number of specialties in the field of pathology. At NYU they include autopsy, breast pathology, cytopathology, including Fine Needle Aspiration biopsy (FNA), gastro-intestinal and liver pathology, hematopathology, molecular pathology and cytogenetics, neuropathology, obstetric and gynecologic pathology, pediatric pathology, renal pathology, urologic pathology, and general surgical pathology.

In the broadest terms, Anatomic Pathology comprises surgical pathology, cytopathology, and autopsy pathology. Anatomic examinations generally involve both gross (i.e. visible to the eye) and microscopic visual examination of tissues. These procedures employ special staining techniques and immunohistochemistry, a process for locating proteins in tissue cells, in order to visualize specific proteins and other substances around the cells.

Anatomic pathologists have been moving more and more toward the molecular level to gain additional clinical information on individual specimens. Although autopsy pathology accounts for less than ten percent of the work of pathologists, it is the most commonly understood function of the pathologist. Surgical pathology is a large area of practice for anatomic pathologists, involving examination of surgical specimens and biopsies from patients. In general, cytopathology describes the microscopic study of diseases through fluids or tissue smears on a cellular level.

Pathologists are board certified in Anatomic Pathology (AP), in Clinical Pathology (CP or Laboratory Medicine) or in both Anatomic and Clinical Pathology (AP/CP), which means that they have achieved the highest level of competence in these branches as verified by a professional board. The American Board of Pathology (ABP) issues board certifications for the following sub-specialized areas for Anatomic Pathology: in cytopathology, dermatopathology (skin diseases), forensic pathology (focus on the cause and manner of death), neuropathology (central nervous systemy, muscles, nerves), and pediatric pathology (child-related diseases).

Clinical Pathology, or Laboratory Medicine, is the medical specialty concerned with diagnosing diseases based on the laboratory analysis of various body fluids such as plasma, urine, stool, mucosal secretions, or cerebrospinal fluid. Many of these tests are automated, with the clinical pathologist responsible for overseeing lab technicians. Clinical Pathologists perform quality assurance and supervision, provide interpretations of more complex studies such as flow cytometry (a microscopic analysis of cell particles in fluid samples through light waves), and serve as consultants to clinicians to determine the appropriate testing for the diagnosis or the assessment of an individual patient’s condition.

For Clinical Pathology the ABP certifies these sub-specializations: blood banking/transfusion medicine (blood transfusion), chemical pathology (clinical chemistry such as body fluid analysis), Hematology (study of blood components), medical microbiology (study of microorganisms), and molecular genetic pathology (disease studies at the genetic level of DNA or RNA). Since another crucial aspect of pathology is dedicated to groundbreaking scientific research in the advancement of medical knowledge, the investigative work of pathologists increasingly encompasses the examination of such cellular and molecular disease processes as well.

Related Links
Pathology Wiki