The Daily Schedule Of An Anatomical Pathologist

Anatomical pathologists focus on diagnosing conditions and diseases based on the microscopic, macroscopic, immunological, molecular, biochemical and immunologic examination of body tissues and organs. 

Training

In order to specialise in anatomical pathology, an Aspiring specialist candidate first has to complete their 5-6 year undergraduate degree in order to become a qualified medical doctor. This is then followed by a 1-2 year internship training phase and once this is completed will allow the doctor the opportunity to apply for a specialist post.

The residency programme for anatomical pathology takes 5 years to complete and the specialist may decide to sub-specialise further. In order to do so, they would have to complete a fellowship training programme that can take 1-2 years to complete.

The sub-specialties of anatomical pathology include the following disciplines:

• Surgical pathology - this discipline is the most time-consuming sub-specialty for a lot of anatomical pathologists. It involves examining surgical specimens and biopsies sent by non-surgical specialists such as dermatologists, general practitioners and physicians.
• Cytopathology - this discipline involves the examination of cells, under a microscope, that are obtained from fine-needle aspirates or smears. These specialists will also perform fine-needle aspirations of cysts, masses or superficial organs. They are then often able to give an opinion and diagnosis in the presence of the consulting doctor and the patient. 
• Oral and maxillofacial pathology - the sub-specialists here are usually dentists, rather than medical doctors, who have chosen to specialise further.
• Molecular pathology - here, techniques such as reverse-transcriptase polymerase chain reaction (PCR) and in-situ hybridization are used for specialised studies of diseases in cells and tissues. 
• Forensic pathology - will be discussed in a separate article.

Procedures in Anatomical pathology

• Gross examination - this is examining diseased tissues with the naked eye. For large tissue fragments this is important because the disease can be visually identified. 
• Cytopathology - this is the examination of loose cells that are spread and stained on glass slides using cytology techniques.
• Histopathology - histological techniques are used for staining tissue (histochemistry) so that it can be observed under a microscope.
• In-situ hybridization - this technique helps to identify specific DNA and RNA molecules on tissue and organ sections.
• Immunohistochemistry - here, antibodies are used to detect the localization, abundance and presence of specific proteins. This process is very important as it aids in characterizing the molecular properties of certain cancers, and distinguishing between disorders with the same morphology.
• Tissue cytogenetics - this technique helps to visualise chromosomes in order to identify genetic defects in patients.
• Electron microscopy - this microscope allows for greater magnification, which results in being able to visualise organelles within cells. 
• Flow immunophenotyping - this technique is very useful for diagnosing different types of lymphomas and leukemias.

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Practice settings for Anatomical pathologists

Anatomical pathologists may be involved in several setups and they can be associated with the following practice settings:

• Academic anatomical pathology - this involves being associated with the university faculty. One of the responsibilities here is the training of under- and post-graduate doctors. 
• Large corporate providers - here, pathologists are employees of a pathology company.
• Group practice - a group of senior pathologists will run a partnership practice that employs junior pathologists to provide diagnostic services to hospitals.
• Multi-specialty groups - these are composed of physicians from various specialties together with pathologists and radiologists to offer a complete diagnostic service.

The Schedule Of An Anatomical Pathologist

The daily duties of an anatomical pathologist, regardless of which laboratory they are working at, is to report on all specimens and samples that are investigated and analyzed by them. This entails that every patient's results are reported as soon as the specialist is done with them. This then allows the referring physician to immediately follow up with these results, query any issues with the anatomical pathologist and give feedback to the patient.

A very important evolution has occurred in anatomical pathology, in that the services that are provided in this discipline have become paramount for the diagnosis and prognosis of cancer to guide treatment decision-making in oncology. 

Monday

Administrative tasks are handled on a Monday such as organizing meetings for the week and determining which laboratories they will be working at. These would include the cytology lab, histology lab and genetics lab.

The anatomical pathologist will spend the day investigating specimens macroscopically (gross examination) and under a microscope and electron microscope to look for any pathologies affecting patients. The specialist will be investigating and analyzing specimens from surgical specialties such as breast surgery, gynaecology, endocrine surgery, gastrointestinal surgery, urology, general surgery involving the soft tissues and head and neck surgery, as well as specimens from dermatologists, general practitioners and other non-surgical specialties.

Tuesday 

Most full day surgical lists occur on a Tuesday, and an anatomical pathologist helping to take specimens will be involved here. They will assist referring surgeons by performing procedures such as fine-needle aspirates to help with the diagnosis of a condition.

The anatomical pathologist will also be responsible for setting up protocols for surgical staff to collect specimens in an appropriate manner.

Wednesday

The anatomical pathologist will be working in the histology lab where they will be receiving specimens from medical and surgical disciplines all over the hospital, and they will be responsible for adequately preparing these specimens for analysis.

Immunohistochemistry, as described above, will be another service the anatomic pathologist will provide on this day.

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Thursday

The anatomical pathologist will be involved in the genetic lab where they will be performing tissue cytogenics and consulting with referring physicians such as geneticists and paediatricians. The specialist may also work in the cytology lab to investigate and report on "Pap" smear specimens which are taken to screen for cervical cancer.

The specialist may also be involved in training under- and post-graduate students and doctors if they are involved with the academic programme of the medical school. 

Friday

The specialist will make sure that all laboratory results have been reported and that they have been logged into the laboratory's server so that referring physicians will have access to the results. Any unfinished administrative issues will then be dealt with and the work week will conclude.

Anatomical pathologists are available after hours if there are any physicians who would like to consult with them.