Patients rarely, if ever, see these physicians, yet they are responsible for diagnosing everything from a benign cyst to a brain tumor.
They are considered the unsung heroes of medicine, often perceived as working only with dead people.
They are pathologists.
Their office, which is a laboratory, has often been called the “black box,” even the “basement.” This is where blood samples, cultures, Pap tests and biopsies are sent.
On any given day they may be diagnosing anything from a mole to pancreatic cancer.
When your physician says he is waiting for lab results, what he means is he's waiting for the pathologist to make the diagnosis. While your physician might strongly suspect your diagnosis based on his experience and expertise, the definitive diagnosis always rests with the pathologist.
“The doctor can’t treat the patient until he knows what we tell him it is,” said Dr. Duane Schultz. “The buck stops here. We take great care in looking at these things because to make a mistake would be a disaster to a patient.”
While spending on laboratory services makes up only 2 to 3 percent of the nation’s health care costs, pathologists are responsible for 70 to 80 percent of patients’ diagnoses and treatment.
They are often called the “doctor’s doctor,” serving as consultants to the patient’s physician.
“Pathologists kind of have to be the bookworms and the detectives,” said Dr. Angela Durden, a pathologist at the Billings-based Yellowstone Pathology Institute. “We have to know a little bit about everything. Pathology is foundational to medicine. We hold medicine up.”
Their job is to ensure that the test results they release to physicians — and ultimately the patients — are reliable and a true representation of what is going on in a patient’s body, Durden added.
“Those decisions your doctors makes are based on those lab tests we touch,” she said.
As a rule, pathologists tend to be introverts and science “geeks,” Schultz said. They would rather spend time studying a specimen under a microscope than talking to someone.
Schultz, who has been with Yellowstone Pathology Institute since 1991, said he should know. He worked as a family medicine doctor for about nine years before becoming a pathologist. While he enjoyed obstetrics and pediatrics, he did not like counseling and that “kind of thing.”
“It wasn’t enough science for me,” Schultz said with a smile. “I love this job. It’s always a sense of wonder for me that there could be such a variety of things that happen. Every day is different.”
While much of their work is done solo and behind a microscope, it would be a mistake to assume they are detached from the patient.
“You cannot forget that there is a human being behind that specimen,” said Durden, the newest pathologist on the team, joining in September 2009.
Schultz echoed the sentiment.
“I don’t like to see potentially fatal cancers in kids,” he said. “That’s probably my biggest shudder experience.”
Dona Cranston, business manager, said she recently attended the American Pathology Conference where one of the guest speakers commented that pathologists are the most “powerful, important people in the hospital” because everyone depends on what happens in the lab.
“This is a big statement, and one that may be open for discussion, but what I do believe is that the pathologist and personnel here perform vital diagnosis for people that would not be possible without their knowledge and expertise,” Cranston said. “Excellent patient care is our goal even though most of our patients are never met face-to-face.”
The five pathologists read at least 26,000 individual diagnostic tests annually. The patients for whom they read tests run the spectrum from newborns to those near death. In 2013, 32 percent of the organization’s charges were Medicare and 7 percent Medicaid. The remaining 60 percent were charges to commercial payers or self-pay.