What is pathology?

At present, some large hospitals in China, such as Beijing, have implemented preoperative notification. When signing before the operation, the doctor must tell the patient's family that rapid diagnosis during the operation is risky and will make mistakes. The probability of this error is How much, but it must be done. Speaking of which, be mentally prepared if you make a mistake. In addition, you may encounter situations that cannot be determined during surgery. For example, it is almost impossible to determine whether a lymph node lesion is lymphoma or reactive hyperplasia. This kind of lesion must be sectioned very well and immunohistochemistry must be done before the final judgment can be made. Sometimes it is difficult to diagnose even if you do this. How can you make an accurate judgment within 20 minutes?

Reporter: Pathological issues are so complicated. Do ordinary people who receive medical treatment in small hospitals have the right to request that their pathology reports or slides be sent to large hospitals for examination?

Zhou: It should be said that it is allowed. The problem is that many people don’t know it now. The media pays too much attention to clinical practice and too little to this area. This requires a lot of publicity to make everyone truly realize this and let patients find ways to learn to protect themselves. Nowadays, many patients have doubts themselves, and then come here with pathological slides, only to find out that they are indeed wrong. Nowadays, there are still many patients who directly come for consultation with the pathology report sheet, wanting to know how to treat the disease from a pathological perspective. In the past, it was impossible for patients to obtain pathology reports, but now the country's laws allow it, and patients have the right to obtain pathology reports. If he doesn't understand the content, he will come to the pathologist for consultation. What I accept now are all things that acquaintances asked me to understand. In fact, pathologists should also go from behind the scenes to the front, face patients directly, open pathology clinics, and register pathological expert clinic numbers. A large hospital in our city has pioneered this, and we are also the first to do so. We are preparing to open such expert clinics to provide more and better services to patients.

Reporter: The first two interviews received a great response after they were published. Readers said that they saw a real diagnosis process of the disease, which was very helpful in communicating the doctor-patient relationship. It was rare to hear about pathology before. With your doctor's voice, everyone thinks you speak very truthfully.

Zhou: Pathology is very practical. This profession requires pathologists to tell the truth. Clinicians may not tell the truth to patients in order to comfort them, but pathologists cannot. Pathologists are not legally allowed to make false reports, otherwise they will be held legally responsible and compensated. Therefore, the pathologist can say one thing and another, even if it is difficult for the other party to accept it, the pathologist cannot tell lies. This is also one of the reasons why pathologists do not deal directly with patients. In fact, it is also a kind of medical protection for patients. Pathologists are often very low-key. There was once a joke widely circulated among pathologists: During the Cultural Revolution, the son of an old director of the pathology department saw that powerful people in society could open various "back doors", and then asked his father, "Why don't you see this?" What kind of backdoor can you, the director, have to open?" The old director replied: "If anyone dies, I can do the autopsy in advance." Although this is a joke, it also shows that it is difficult for pathologists to seek personal gain.

Reporter: Will other hospitals or smaller hospitals send pathological slides to you for consultation?

Zhou: Yes, there are many now. In the past, there were more than 200 consultation cases every year, but now there are nearly 3,000 out-of-hospital consultation cases. Here I want to talk about a misunderstanding, which is the hierarchical management of hospitals. Everyone wants to be a second-level hospital or a third-level hospital, and all large and small hospitals have established pathology departments. Therefore, hospitals that do not have the conditions to establish pathology departments have also established pathology departments. Some hospitals have only one pathologist in the pathology department, or even only one person in the general practice, who serves as both a doctor and a technician. This is very, very dangerous. Regardless of his level, he makes decisions alone, and if he makes a mistake, it is 100% wrong for the patient. Large pathology departments have a group of people, and everyone has a discussion. Generally speaking, it is impossible for everyone to make mistakes at the same time, so the probability of mistakes in large hospitals is of course relatively low.

Also, young pathologists in large general hospitals often have to work with senior doctors for five years before they are qualified to issue pathology reports independently. However, pathologists in some small hospitals are required to take the lead and issue pathology reports as soon as they arrive. His training and knowledge are incomparable to those of large hospitals. A large hospital can see 10,000 cases a year, while a small hospital only sees a few hundred cases a year, and there are very few opportunities to go out for meetings and exchanges. You It is almost impossible to ask him not to make mistakes. Therefore, I suggest that small hospitals should not pursue small but comprehensive operations. Small hospitals can carry out surgical operations, but they do not necessarily have to establish pathology departments. They can send specimens to large hospitals for processing and pathology centers for processing. This is very popular abroad. practice.

In addition, I would like to remind patients through the media that some hospitals now do not pay attention to pathological specimens and throw away the specimens without a pathology department. Patients have never thought of asking clinicians for pathological diagnosis reports. This is Wrong. According to medical regulations, all isolated human tissues must undergo pathological examination. You said it's not cancer. How would you know without a pathological examination? You said it was cancer, but was it finally confirmed by pathology? Therefore, the patient must ask the clinician for questioning. This is not only a basis for future re-examination, but also an important basis for litigation. A well-processed specimen, especially a paraffin-embedded tissue block or pathological section, can be stored for a long time. Pathology reports are also part of the medical record and are equally important