Can Technology Rescue Pathology?

This critical sector is under pressure. Digitisation might be its saviour.

Pathology plays a crucial role in the diagnosis and treatment of diseases. Pathologists are the primary people involved in diagnosing diseases like cancer, grading disease severity, and predicting response to therapy. It is their decisions that give doctors the diagnoses needed to ascribe the correct treatment, and to fight gruelling diseases in the most painless and timely way possible.

Without pathologists, the medical world as we know it would not function. In spite of this, the field of pathology is one of the most underappreciated and unacknowledged fields of medicine.

Pathology is chronically underfunded

One of the most apparent examples of this underappreciation is the chronic underfunding of clinical laboratories in the healthcare industry.  This underfunding can manifest in several ways, such as a lack of resources, outdated equipment, insufficient staffing, and inadequate training. As a result, many histology labs struggle to keep up with the demand for their services, leading to delays in diagnosis and treatment, and increased costs for patients and healthcare providers alike.

Additionally, the lack of investment in histology labs can lead to missed diagnoses, misdiagnoses, and errors in patient care. In such a vital sector, negligence is unacceptable and puts lives at risk.

Pathologist numbers are down

The issues mentioned above are worsened by a fall in practicing pathologists. However, it can all be viewed as a negative feedback loop. The treatment of professionals in the sector, combined with the reluctance to invest into this area of medicine is forcing pathologists to ditch their dream job for a career in a less stressed and better resourced sector of medical care. Worse again, it’s what is discouraging young aspirational, talented young pathologists from entering into the sector.

To discuss the latter first, one reason for this is the changing landscape of medical school curricula. In the past, medical students received extensive training in pathology, with courses and rotations dedicated to the subject. However, in recent years, medical school curricula have shifted to place more emphasis on clinical skills and patient-centred care, often at the expense of basic sciences like pathology.

This shift in emphasis has led to a decreased understanding and appreciation of pathology as a vital component of modern medicine. Medical students may not see pathology as a career path because they have not received sufficient exposure to the subject in their training. Additionally, they may not fully understand the critical role that pathologists play in the diagnosis and treatment of disease.

Furthermore, the perception of pathology as a career path has been negatively affected by the misconception that it is a “behind-the-scenes” specialty, with little patient interaction or direct impact on patient outcomes. However, this view is not accurate, as pathologists play a crucial role in determining the most effective treatment options for patients and in improving overall patient care.

Another situation exacerbating the issue of falling pathologist numbers is the pension issues associated with the career. Many pathologists are choosing to retire earlier than they would like due to issues with their pension plans, such as low payouts, changes in eligibility requirements, and other financial concerns.

Many pathologists are also choosing to emigrate to countries like Australia, New Zealand, Canada, and the United States, which offer better pay and working conditions than their home countries. This trend has led to a shortage of pathologists in some areas, which can have serious consequences for patient care.

The shortage of pathologists can lead to delays in diagnosis, misdiagnoses, and errors in patient care. It can also increase the workload for the remaining pathologists, leading to burnout and a decrease in the quality of work. Additionally, the shortage can have economic impacts on healthcare facilities, as they may need to pay higher salaries to attract and retain qualified pathologists.

Reliance on locums to fill staff shortages

Using the UK as an example; £50m is spent on pathology locum/backlog management services in the UK. Only 3% of NHS hospital pathology departments are adequately staffed to meet clinical demand with 50% of UK labs require locum staff to meet turnaround time metrics at a cost of  £27m Per Annum. 45% of UK labs outsource work and 3-5% outsourced to backlog companies equating to 350,000 cases per year.

All of these factors show a clear picture of how the pathology sector is struggling. This is even without mentioning the physical aspect of the job. That is, the requirement for pathologists to spend long hours studying glass slides under a microscope. The repetitive nature of this work can lead to occupation-related eye strain, headaches, and other physical and mental health issues.

Digital pathology’s role in clearing backlogs

Digital pathology has the potential to address many of the issues related to pathology working conditions. By digitising pathology slides, pathologists can review tissue samples using a mouse or spacemouse to traverse through the image quickly to look at specific sections and move between slides at a click of button, as well as a monitor to view images in a more ergonomic manner, reducing neck and back pain. This is in contrast to the traditional method of mounting and dismounting each individual slide, and adjusting the coarse and fine focus knob to review each sample, which takes a significantly longer amount of time. All this saved time per case, per day, per year adds up. In short, digital pathology allows pathologists to review more cases faster. With increased efficiency comes faster diagnoses, less testing backlogs, and overall a better standard of care. For the pathologist, it means a less stressful work environment, and better quality of life in general.

Digitisation is changing the perception of pathology

Not only does digital pathology relieve most of the stresses on the pathology industry including test backlogs and delayed diagnoses, digital pathology is also slowly but surely changing the perception of the profession to young medical students considering what sector of the medical industry to move into. Younger medical professionals and students have grown up in the digital age, where technology has been core parts of their lives. As a result, they have a great understanding and excitement for innovative technology solutions. For this reason, pathology is now becoming more attractive to young doctors as technology-based approaches surge. Not only this, but younger people have a greater trust for technology than older generations and have greater expectations of being equipped with up-to-date, innovative tools that allow them to work more efficiently and better use their skill set.

A new level of collaboration

Collaboration is a vital part of a clinical pathologist’s work. Often, healthcare professionals will ask a colleague for their advice on a particular case for a second opinion. ‘Corridor consults’ have been popular occurrences to get quick, informal advice from colleagues.  Not only does digital pathology enable collaboration as well as current methods, but in some cases it improves collaboration. 

The best eyes, not just the nearest eyes

Now, a pathologist can share a screenshot of a complex case via email or instant message for second opinion, without the need to leave their chair. Additionally, and even more beneficial, a pathologist can share a case with a pathologist thousands of kilometres away. This offers access to expert subspecialist pathologists for a specific case, meaning the best eyes are giving a second opinion on the case, not just the eyes nearest.

A better work/life balance for pathologists

With this idea of collaboration and networking of the world’s pathologists comes another way to improve pathology working conditions. That is, providing hospitals access to remote pathology services. With digital pathology, pathologists now have the ability to work from the comfort of their home office to onboard cases from hospitals with large backlogs. This evidently is a win-win situation – digital pathology consult services enable pathologists to work remotely, meaning less time travelling to and from an office, more time for family and personal obligations, and overall, improved work life balance. For hospitals, this means less test backlogs, less staff under extreme pressure, and improved turnaround times and patient outcomes. Not only this, but digital pathology consult services offer access to subspecialist pathologists for specific cases. As alluded to above, this offers a greater standard of care, improving patient prognosis.

AI reduces laborious, repetitive tasks

Finally, the promise of artificial intelligence and algorithm tools to enhance accuracy, efficiency and provide objectivity hold much promise to revolutionise the practice of pathology. Laborious and time-consuming aspects of a pathologist’s time can be saved by applying such tools to triage, prioritise and augment diagnosis of caseloads.

Whilst the pathologist will remain central to the diagnostic process, equipping them with powerful tools to alleviate the mundane aspects of diagnostic work, liberating them to provide meaningful and impactful information and contributions to patient management.

Challenging times, but the future looks promising

In conclusion, the field of pathology plays an essential role in the diagnosis and treatment of diseases, yet it remains one of the most underappreciated areas of medicine. Pathologists have to deal with challenges, such as chronic underfunding of clinical laboratories, earlier retirements due to pension issues, and immigration to countries with better working conditions, not to mention the physical challenges of the profession. However, with the advent of digital pathology, many of these challenges can be addressed.

The digitisation of pathology slides enables pathologists to review more cases in less time, reducing backlogs and improving overall patient care. The promise of artificial intelligence and algorithm tools further underscores the potential of digital pathology to revolutionise the practice of pathology and improve patient outcomes.

Furthermore, digital pathology is changing the perception of the profession to young medical students, who are now more attracted to the sector as a result of its innovative technology solutions. It is vital to recognise the importance of pathology and the need to invest in and adopt digital pathology as a solution to this problem to improve the quality of patient care in the future.

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