Pathologists Behind the Scenes – At the Forefront of Health Care

When the CEO of a certain, not-to-be-named hospital system asked Karim Sirgi, MD, MBA, then the chairman of the pathology department and president of the medical staff, “What do you pathologists do? I know you come to work every day, but no one sees you,” Dr. Sirgi responded: “The best way to understand what we do is to imagine a hospital without pathologists. Although we are invisible to the patient, invisible to many physicians, and invisible to most administrators, without us, medical care comes to a screeching halt.”

Without pathologists, medical care stops

From the primary to the tertiary care setting, remove the pathologist from the equation, and clinicians are navigating blind. “In fact, 70% of medical decisions are made only after lab tests have been obtained” comments Dr. Sirgi, Owner and Principal at Sirgi Consulting, LLC - Reigniting Medical Group Synergy.

In a tertiary care setting, the pathologist’s role is even more complex than in the primary care setting, often escalating from lab tests to a biopsy to surgery and the removal of a segment of, or an entire, organ. This gradation of care is completely dependent upon the expertise and judgment of pathologists. “Think of it this way,” comments Dr. Sirgi. “After a biopsy, somebody tells the patient, ‘We won't know for sure what to do until we get a report,’ and behind this report, the patient has no idea there’s a physician who has specialized in the specialty of pathology for four years and has sub-specialized for two to three additional years. The patient will almost never meet that physician, almost never talk with that physician—and yet that pathologist’s conclusions may well determine the rest of the patient’s life.”

Why pathologists are invisible

While Dr. Sirgi is not one to point fingers, if he were, he’d say there’s plenty of blame to go around to explain why so few understand the work pathologists do. To address this gap, improved communication across a wide spectrum of audiences is key: “Pathologists don’t need to focus on educating one audience,” notes Dr. Sirgi. “Their responsibility calls for a constant effort to educate multiple audiences—from clinicians to administrators to legislators to the public-at-large—and each one of these audiences has their own sets of interests and priorities, and a language very specific to what they do.”

How can pathologists be seen and their value known

Pathologists must learn how to translate their work and its impacts—depending on how those impacts apply to a particular audience. In more detail, to ensure the visibility of the critical value pathologists provide, Dr. Sirgi believes pathologists must:

1. Introduce themselves to their clinical counterparts. “I’m not talking about sharing a business card,” remarks Dr. Sirgi, “I’m saying pathologists need to take the time to explain what they do—without lecturing—and encourage clinicians to call them if they need them.” According to Dr. Sirgi, silence has no place in building relationships, and only amplifies the distance between the laboratory, clinical, and administrative staff: “Pathologists already operate in labs often hidden away in basement suites,” which means their work is already invisible to critical stakeholders. “Moreover, pathologists cannot depend on overbooked clinicians to knock on the lab door, and ask ‘What do you do?’” And surprisingly, physicians who don’t interact with pathologists regularly are often ignorant about pathologists’ work. “That’s why we pathologists hear comments like ‘So how are the dead bodies today? I guess you're not getting any complaints from your patients today’—and just for the record, our work with dead bodies represents less than 0.01% of our time.”
2. Show some love to administrators. Dr. Sirgi emphasized the importance of pathologists working with administrators to establish a relationship of common understanding about what each group does. According to Dr. Sirgi, pathologists are often at an immediate disadvantage with administrators because what pathologists bring to the table is often unknown. The result? Pathologists often feel unappreciated and misunderstood—and unsupported by the administration. Dr. Sirgi understands that “…administrators are not coming to work every day thinking, ‘I’m going to ’piss off’ a pathologist today because that's my mission in life’; the discord is based on a misunderstanding between two parties of the critical role each plays in the overall success of the institution.”
3. Serve as a translator and exercise cultural intelligence when communicating their skills to others. Dr. Sirgi encourages pathologists to “read the room carefully” and avoid using an internal specialized vocabulary when speaking to parties operating outside of the lab; using a highly technical vocabulary often works only as a soporific for those outside the lab. Furthermore, Dr. Sirgi emphasizes the importance of being respectful of each audience’s predilections—and that’s about having a high level of CI—or cultural intelligence. As Dr. Sirgi explained, “Let's put it this way, wherever you are, you could be talking with a predominantly white or predominantly black audience, or where the administrator is Indian, or of Middle Eastern Heritage, or of Asian Heritage—and in each setting, cultural intelligence is going to make a huge difference about how those conversations go.”
4. Work to change the perception of the public at large about what pathologists do. Dr. Sirgi notes that “When a neighbor asks me what I do, and I say, ‘I’m a pathologist,’ one of two things happens: I either hear the “Oh, you work with dead people” comment or more often, I get just a blank stare or an eye roll. If I were a cardiologist, a radiologist, or a dermatologist, everyone would know what I do.” Dr. Sirgi doesn’t blame his neighbors for this definitional ignorance: “It isn’t the fault of my neighbors: it’s the fault of the community of pathologists who have failed to educate the public about the role of pathologists in their health care.”
5. Highlight the role of pathologists in overseeing the quality of all lab tests across all specialties and sub-specialties. Pathologists are ultimately responsible for the quality of tests originating from a lab. “Whether it's in a primary setting or tertiary care setting, ensuring the accuracy and quality of testing is the pathologist’s primary function,” remarks Dr. Sirgi. Furthermore, pathologists’ ability to oversee all manner of lab tests reflects their role as what Dr. Sirgi calls ‘connectors’: unlike cardiologists, who specialize only in heart-related issues or dermatologists who focus on skin health, pathologists have to know about every organ, or know to whom a clinician can turn based on subspecialty training. “So, by the very nature of our practice, we are a multi-department, multi-specialty, multi-operation connector,” concludes Dr. Sirgi. In other words, pathologists are essential to coordinating quality of care, which is often an intangible, but critically valuable asset to any institution.
6. Promote the understanding that not all pathologists are created equal. “Most people don’t understand that pathologists, similarly to their other medical specialty colleagues, come in a variety of specialties and subspecialities,” says Dr. Sirgi. “Just having a pathologist isn’t the answer: you have to have the right pathologists to meet the needs of particular patients.” For example, as Dr. Sirgi remarked, “You wouldn’t want a dermatologist to be the only physician on call if you are having a heart attack, and if you are suffering from a blood cancer, you want a pathologist with a specialty in understanding blood cancers.”
7. Refine the image of how pathologists are portrayed on TV and in movies. “Hollywood has a very important cultural impact on how we perceive things,” says Dr. Sirgi “Think of the many harmful stereotypes Hollywood promotes: people from the South are portrayed as ignorant with funny accents, and Wall Street types are always greedy and soulless.” As for pathologists, Dr. Sirgi describes the two stereotypical extremes: on CSI, for instance, the pathologists are all gorgeous models working in a polished high-tech lab that is science fiction clean with shimmering blue lights. At the other extreme, on many detective and police dramas, the pathologist is dirty, unshaven, and eating a sloppy sandwich over a corpse during a procedure while making off-color jokes to the detectives.” These extremes fail to capture reality 99.9% of the time, notes Dr. Sirgi.
8. Embrace a leadership role at a national level regarding matters of general policy and legislation. Dr. Sirgi believes pathologists need to bend the ears of their senators and legislative staff to educate representatives about the key impacts of their work—both financial and in terms of health care quality. “I want to encourage more pathologists to visit Washington, DC, and make clear the critical impact of their work on quality health care. The recent pandemic definitely highlighted the heroic work of my colleagues in the awareness of many policy makers and decision-makers, but way too many people are still oblivious to the fact that behind every PCR test that detected a killer virus and allowed early life saving treatment was the hard work and expertise of a pathologist supported by countless laboratory professionals tirelessly working behind the scenes.”

In conclusion, pathologists must work to correct the incomplete understanding of the value they bring to health care and expand their reputation beyond the confines of the laboratory itself. Closing the gap between what pathologist bring to the table and what administrators and the community at large believe will not happen overnight. Pathologists must find unique opportunities for conversations, and for networking opportunities in their communities and in their neighborhoods to correct the common perception—or rather misperception—about what they do, one person at a time, one environment at a time. In an apt analogy, Dr. Sirgi notes, “It’s like exercising: you don't become an athlete overnight when you exercise, but over time and with repetition, you can achieve your goals. The same is true for us as pathologists. I know that with persistence and effort, the value of our work will begin to register with others—to the benefit of all.”

Karim E. Sirgi, MD, MBA, FCAP, owns Sirgi Consulting LLC and offers expertise to medical groups in various aspects of practice management and leadership. Dr. Sirgi is board-certified in anatomic, clinical and cytopathology with additional surgical pathology fellowship training, he also holds an MBA and has 30 plus years of practice and leadership experience in private, academic, and hospital-based pathology and medical staff settings. Among his previously held positions, Dr. Sirgi served as president of the largest multi-specialty pathology group in the Rocky Mountain region and chair of the regional medical staff council for the largest hospital organization in the US. Dr. Sirgi is the immediate past-president of the American Pathology Foundation, the chair of the CAP Practice Management Committee, and the Chief Science Officer of Breath Tech.