Rules of Thumb

A Pathologist's Guide to Our Real Patients

Ed Uthman, MD

Diplomate, American Board of Pathology

29 January 1998

Yeah, I know. We laboratorians are always going on and on about how we are really involved in direct patient care, that what we do is just as important as what the nurses and real doctors do, that we would never do anything not in the patient's best interest, no matter how well-connected the doctor asking us to do it is, yadda yadda yadda. Right.

In fact, we all know that we are just a bunch of shopkeepers, and the real customers are the clinicians. And the customer is always right, n'est-ce pas? Anyway, after years of keeping shop, we all come to develop certain rules of thumb concerning our customers. See if yours agree with mine:

  1. Clients with boring names, like "Trask County Oncology Consultants" or "Rebecca Smith, MD, PA" are usually solid physicians. Clients with Madison Avenue names like "TotalWoman's NuHealthnessCenter" are suspect.

  2. You will never be able to make an accurate definitive pathologic diagnosis on the punch biopsy of a skin rash, unless the biopsy was taken by a dermatologist. You will report out all other such biopsies with nothing more than descriptive goobledegook, or you will try to please and quixotically attempt a definitive diagnosis, which will be wrong and will be rubbed in your face by the dermatologist to whom the patient is eventually referred, and by your competitor across town, who is actually a worse pathologist that you are, but got the diagnosis right because the dermatologist who sent him the follow-up biopsy gave him the answer in advance.

  3. Ostentatious trappings of wealth in a surgeon or other procedure-oriented specialist is usually indicative of a competent physician with a successful practice. Ostentatious trappings of wealth in a physician in a cognition-oriented specialty probably means he or she is running a scam or is siphoning off income from a protean stable of hired physician short-timers and walking-wounded, who generate a lot more revenues than they are paid.

  4. In a surgeon, flat affect and mask-like facies are evidence of focus and technical competence. In a psychiatrist, flat affect and mask-like facies are evidence of mental illness.

  5. The best male internists are usually a little scruffy-looking. However, a scruffy-looking plastic surgeon is probably headed for a psychotic break or is going through a divorce. Scruffy-looking female physicians are usually technically competent but are less than successful because of the perceived lack of "people skills" by their patients and bosses, despite the fact that style and grooming have nothing to do with empathy and compassion.

  6. The male physicians with the least glamorous wives are the most happy, while the female physicians with the least attractive husbands are the least happy.

  7. The female physicians with the biggest hair are psychiatrists and dermatologists. The two may be distinguished by the greater volume of makeup worn by the former.

  8. The number of skin biopsies you get from a client is directly proportional to the probability that he or she will punch-biopsy a pigmented lesion and shave-biopsy a rash.

  9. The competence of a gynecologist is directly proportional to how upset he or she gets at the high number of ASCUS Paps you report.

  10. Ill-tempered physicians get the best treatment from the lab and the worst treatment from the nurses. Congenial physicians get the worst treatment from the lab and the best treatment from the nurses. Unlike nurses, laboratorians have just not mastered the art of passive-aggressiveness.

Of course, there are exceptions to all generalizations, and, needless to say, present company is excluded.

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