The Rapidly Disappearing Science and Art of Pathology in Developing Countries

Abstract

The carefully learnt and traditionally transferred art and science of observation, precision and distinguished unparalleled competence is diminishing its glory into the dark horizons through its disintegration in multiple new disciplines, high technological advancements and non-sustenance with the pace of rapid scientific growth. Such a scenario is resulting into general disinterest of medical graduates into the discipline of Pathology, low morale of its practitioners and near absolute termination of opportunities to grow among the subject experts. A loud thinking is necessitated among the medical fraternity, in general, and pathologists, in particular, to device the ways and means of rejuvenating the ever rusting status of Pathology. This shall not only enable enthusiasm among its practitioners, but also generate new ventures for innovations, education and research. The article highlights the intrinsic and extrinsic, but closely interwoven factors, situations and circumstances, which if dealt with great care shall yield rich dividends towards reverting the current trend, develop future models of growth and sustainability in the field of Pathology. A pathologic diagnosis is the result of a complex series of activities, mastered by the pathologist. The nature of these activities is, however, rarely talked about in depth. The medical literature occasionally discusses aspects of the pathologic diagnosis processes, generally departing from the pathologic practice. The process of diagnosis can be viewed as an action plan, encompassing four domains of cognitive, communicative, normative, and medical conduct. The cognitive domain involves processes of perception, attention, memory, search, hypothesis creation, and verification, among others. Communicative skills consist of providing arguments in support of a diagnostic conclusion, with adequate clinical and relevant pathologic information. Pathologic diagnosis is also subject to technical rules (based on empirical experiences), rules of rational choice (strategies aiming at definite goals), and consensual rules among peers. (1) Pathology services represent the rational, scientific basis of the practice of clinical care. It does not represent deus ex machina, an implausible solution to a complex plot, but rather the way in which clinical care can be audited, controlled, guided and kept appropriate to the funds and the skills available. (2) Effective utilization of clinical laboratories requires that underutilization, overutilization, and mal-utilization be appreciated and eliminated or reduced. (3) New and expensive treatments, introduction of difficult to interpret complex tests, a greater reliance on nurse practitioners as deliverers of primary care and patient initiated testing, all make it likely that in the future greater emphasis will be placed on appropriate use of cost-effective laboratory tests. The most promising solution to inappropriate utilization of laboratory services is a greater reliance on clinical laboratory consultants. At present, many laboratory physicians and scientists cannot compete with specialist physicians in terms of the ability to provide credible helpful advice on test selection and results interpretation.