Four sins that put pathology in crisis An occupying lesion, inflammatory or neoplastic? Is it benign or malignant? Clinicians and imaging physicians can fully express their opinions, but the final arbiter is the pathologist. Pathologists are often the “last word” in clinical diagnosis. However, this group of people is becoming less and less important in diagnosis, because no one wants to stay in a department where there is no hope. The level of the pathology department represents the level of the hospital The real clinical people attach great importance to the role of the pathology department. Qiu Fazu, Zhang Xiaoqian, etc. are extremely respected for the work of clinical pathology. Academician Zhong Nanshan said, “The level of clinical pathology is an important symbol of the quality of medical care in the country.” Professor Zhang Naixin once said that the level of a hospital’s pathology department represents the level of a hospital. The reason is simple – pathological diagnosis is the final diagnosis. Can a hospital that can’t even get the diagnosis right pray to provide a high level of service to patients? In today’s complex doctor-patient relationship, the pathology department plays a role in escorting the normal diagnosis and treatment. The development of pathology has benefited from technological advances; likewise, the development of pathology has driven the continuous development of modern medicine. Pathological diagnostic results are now not only used to determine the nature and classification of lesions, but also increasingly suggest the prognosis of tumors and are used directly to guide the use of medications. For example, the clinical presentation and pathological pattern of breast cancer are both invasive ductal carcinoma, but whether the patient is positive or negative for hormone receptors, human epidermal growth factor receptor-2 (HER2), the treatment options are very different and the prognosis can be very different; HER2-positive patients have a poor prognosis and a high chance of metastasis, but this type of breast cancer is more sensitive to targeted drugs. If the patient is estrogen or progesterone receptor positive, then endocrine therapy should be administered. Breast cancer from diagnosis, staging, and detection of receptors (immunohistochemistry and fluorescence in situ hybridization) are done by the pathology department. Pathologists are present in all aspects of the treatment of breast cancer patients. Pathology is the bridge between basic and clinical disciplines. The translation and application of molecular biology techniques, molecular genetics and new drug development in the clinical setting requires the involvement of pathologists. Recently, a major breakthrough was achieved in a collaborative project between our Department of Pathology and the Academy of Military Medical Sciences – a milestone in breast cancer drug resistance gene research. The article was published in Nature Medicine, the world’s leading academic journal. Pathologists have played an irreplaceable role in this project. In recent years, pathologists are continuously translating theoretical understanding of molecular biology research into practical results for diagnosing diseases, determining disease prognosis and guiding clinical treatment of diseases. In a way, pathology not only serves the clinic, but also guides the clinic. Why is the Department of Pathology facing development difficulties Clinical pathology is so important, but it is currently struggling and facing difficulties. One sin: serious brain drain Undergraduates from medical schools stay in school for assignment and postgraduate students rarely choose clinical pathology, and some postgraduates in pathology choose other clinical departments after graduation. One of the main reasons is that pathologists have high risks, heavy tasks and low income. They don’t have the thrill of the operating table or the eloquence of the internal medicine grand rounds. They spend most of their time sitting in front of a microscope, looking at a square inch under the mirror, in the red and blue images, using their knowledge, accumulated experience and immunohistochemistry and molecular pathology detection means to make a judgment on the nature of the disease. Their merits are not remembered, but their mistakes are hardly forgotten. Only when medical disputes arise, pathologists can come to the forefront, sometimes as “scapegoats”. In the long run, the brain drain is serious. The second sin: being classified as an auxiliary department The pathology department is classified as an auxiliary medical technology department with Chinese characteristics, because in developed countries, the pathology department is a standard clinical department. Because of this, the pathology department enjoys a lot of “auxiliary” treatment, such as a low percentage of income commission, but also to give the checklist department “kickbacks” and so on. This is a very funny thing, as if the police patrol received a report to the scene to give the reporter a benefit fee. In many hospitals, pathologists also have revenue targets, which is as dangerous as asking the police and military to generate revenue. Three deadly sins: charging only 40 yuan for three busy days In Beijing, pathology examination fees have persisted for 30 years and remained stable for a long time, but diagnostic costs and diagnostic risks have doubled several times. Taking image-guided organ puncture as an example, a single puncture is charged nearly 1,000 yuan by clinical departments. The size of the tissue sent for examination is measured in millimeters, and the pathologists and technicians are busy for 3 days, taking, producing, observing, and examining at three levels, while the experts and professors are diagnosing under the risk of “peeping into the tube” and “blinded by a leaf”, but the fee is only 40 yuan. This is in great contrast to the high mental and physical investment of pathologists, and is also puzzling to foreign colleagues. Four Deadly Sins: Defective Division of Disciplines The division of disciplines prevents pathology disciplines from training clinical pathology postgraduates. China’s disciplinary division classifies pathology and pathophysiology together as a secondary discipline of basic medicine, and there is no tertiary discipline of clinical pathology, so pathology postgraduates are classified as basic medicine (scientific research), and cannot recruit and train clinical pathology postgraduates, and even the postgraduates graduated from scientific pathology are not qualified to take the licensing examination, which makes the master and doctoral students of pathology The postgraduates are diverted to other fields after graduation, which causes further personnel loss in the case of shortage of pathology postgraduates. Due to the lack of talents, the level of pathology diagnosis in China varies, especially in small and medium-sized hospitals, and there is a high rate of misdiagnosis for some difficult cases, resulting in patients or families bringing pathology slices for national consultation, which causes unnecessary economic and medical resource burden. The government urgently needs to correct policy deviations There are many reasons why pathology departments are in trouble, both in terms of national macro policy mistakes and hospital misconceptions. In the context of an industry-wide crisis in pathology, the PLA General Hospital has handled this issue more scientifically, adopting many tilted policies to support the clinical pathology diagnostic specialty, making this side of the scenery unique. The hospital declared the pathology department as a non-profit department, which lifted the shackles of profitability tied to us. We have also taken care of the fee commission, cost accounting and staffing. In the past few years, our pathology department has been developing well and is at the forefront of the domestic pathology community, but we still have a long way to go to turn around completely and achieve a virtuous cycle. We sincerely hope that the government can formulate more reasonable policies to fundamentally improve the status of the pathology department; the hospital can liberate its mind and have foresight to recognize the importance of the pathology department, so that the pathology department can play a greater role in the treatment process of patients. The medical profession cannot resent the poor and love the rich “Pediatrics, pathology, microsurgery, etc., which do not earn money, are increasingly struggling.” This is the lament heard by the reporter in an interview. Many prominent experts have also repeatedly called for ways to stop the decline of these disciplines and not to let them be annihilated in the tide of the market economy. About microsurgery, the Chinese Medical Association Microsurgery Branch of the chairman-designate, the First Hospital of Sun Yat-sen University, Vice President Professor Liu Xiaolin once had an incisive explanation. He said, microsurgery is both a discipline, with basic theory, discipline construction support, but also a technology, like a computer in many departments to use. Moreover, the birthplace of microsurgery in China, is the “ping pong” of our medical profession. However, at present, whether it is called the national essence of microsurgery, or high gold content of the Department of Pathology, or poor as the Department of Pediatrics, due to unreasonable system, market-oriented, talent training mechanism and other reasons together, resulting in the Department more and more shrinkage, serious brain drain, weak development, the seriousness of the problem has reached the point where we must save. To this end, we call for: patient demand is the real guide, the medical profession can not be too poor to love the rich; do not cause the development of the discipline to stagnate because of our inaction, so that the “debt” can not afford to pay!