"I have seen some people who seem to be able to do both; but they are the exception. Actually, if you look at them closely, you will find that most of them are very good at one aspect and just competent on the other"
Juan Rosai (Argentina, USA and Italy)

  More quotes on Research versus Clinical Work

For many pathologists there is a fundamental tension between an interest in research and their commitment to service work.  Juan Rosai explains, “It is the most difficult thing in the world.  Many pathologists are caught in this dilemma, and some suffer from it.  But at some point in your career you have to face the issue and make a choice.”   

Rosai himself chose the path of surgical pathology, which appealed primarily because of “the satisfaction of looking at cases and making a diagnosis... It gives me the feeling that by doing that I am helping patients.”  He believes service and research work require different mindsets. “I have seen some people who seem to be able to do both; but they are the exception. Actually, if you look at them closely, you will find that most of them are very good at one aspect and just competent on the other.”

In the traditional countries basic science was what gave you credibility.Rosai traces this tension to the development of pathology as a profession over the centuries.  The specialism started off in Renaissance Italy with physicians exploring what lay behind the deaths of their own patients.  In the 1800s, “it took a very significant turn under the influence of Rudolph Virchow.  Virchow was a scientist.  He was not very interested in diagnostic pathology or in clinico-pathologic corelations; he was interested in understanding the mechanisms of disease.”

Christopher Fletcher, talking as someone working now in the US, sees the ramifications of this development today. “In this country the National Institutes of Health, which hands out billions of dollars in research funding, supports very good science that understands basic disease processes.  But the amount of that that actually ends up being relevant to patient care is negligible.”  He goes on to say that basic science is still “the definition in many countries of what represents good pathology. In the traditional countries, England being clearly one of them, basic science was what gave you credibility.”

There are clear exceptions to the general rule.  Jeffery Taubenberger has managed the tensions to work successfully in both worlds.  Early on in his career a key role model, Timothy O’Leary, showed Taubenberger “that my dream was possible – that you could still keep a hand in pathology, a hand in clinical medicine, but also do basic science.  I was inspired by the fact that, although he was doing a lot of basic science, he was still an excellent and caring physician.”

Although he was doing a lot of basic science, he was still an excellent and caring physician.Elaine Jaffe believes that having a foot in both camps can be a strength rather than a source of tension:  “As pathologists we see the disease more in its entirety -- in terms not only of its morphologic features or its molecular pathogenesis, but its clinical features also, and this is very important.”

Kenneth Hillan, now working in the pharmaceutical industry, maintains that you do not need to have direct contact with patients to feel you are contributing significantly to their care.   “Potentially, you can have a much bigger impact on the lives of patients by bringing new medicines to specific diseases,” he says.  “If you look at drugs like Herceptin or Avastin, really the impact you have on patients' lives -- and on physicians' ability to prescribe for patients with diseases that previously weren't treatable -- is pretty incredible.”

Key interviewees: Christopher Fletcher, Kenneth Hillan, James Ironside, Elaine Jaffe, Juan Rosai, Jeffery Taubenberger, Maesha Deheragoda, Julia Polak

See also: Attributes of a Pathologist

 

QUOTES

Juan Rosai[When I first moved to the US] the research of a surgical pathologist was anatomically based, it was done using the same tools that we used for our diagnostic work. In a way, our research was an extension of our diagnostic work. It was, as we called it, clinico-pathologic research, of which Dr Ackerman was a master.

That school of surgical pathology is not so much interested in the basic mechanisms of disease, but in the clinical implications of the pathologic findings. So after having trained with Dr Lascano in Argentina and Dr Ackerman in the States, I became that kind of a surgical pathologist. I am not, and I have never been, a basic scientist looking for the fundamental mechanisms of disease.

 - Juan Rosai (Argentina, USA and Italy)

Jeffrey TaubenbergerThe rewards of medicine and the rewards of basic science are usually quite different. In a sense they’re complementary. In medicine you can get satisfaction in a much shorter timer period, in that you do something and there’s an outcome and you receive satisfaction. 

To take a very simple example: somebody comes with an appendicitis and has an appendectomy, and is saved when otherwise they would have died, and that’s enormously satisfying – hence the egos that surgeons develop! That kind of instant gratification is very rarely, if ever, seen in science. You know, if you have that sense, it’s probably because it’s wrong!

 - Jeffery Taubenberger (USA)

Elaine JaffeI never had this Florence Nightingale fantasy of healing the sick... I didn't go into medicine because I could help humanity; I went into it because I thought it was interesting to study.
 - Elaine Jaffe (USA)


Nicholas Wright[Pathology] is the easiest subject from which to design a research project. For pathologists, every time they sit down in front of the microscope to do a load of surgical cases, with every slide they put beneath their microscope there is a problem to be solved, if only they can identify it. It's there for you to ask the question -- and the techniques are there now for you to answer that question. And so if you're interested in research at all, pathology's the ideal discipline to take up. 
 - Nick Wright (UK)

Chris FletcherThere's a sense among clinicians [at the Brigham and Women's Hospital, Boston] that pathology is very important. I think, actually, the concept of surgical pathology -- which is what you're really talking about, diagnostic histopathology -- was partly created in [the USA]. And it was created largely by surgeons, believe it or not, who wanted to have diagnostic answers. 

Pathology was always a research thing, with a [diagnostic] report being a secondary phenomenon, and I wonder if in England that problem was never really addressed. I mean, there were always these serious academic types that people respected, but maybe somehow the pathologist was never really integrated into the fabric of clinical care in the same way that they are here. I really don't know…that's a tough question.

 - Christopher Fletcher (UK and USA)

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