By Evan Falchuk
The first thing you see when you enter the Toronto General Hospital’s Pathology Department is a prominent sign bearing a quote from Sir William Osler. “As is your pathology, so goes your clinical practice,” it says. It’s the first clue that there is something special happening here.
Dr. Silvia Asa is the Chief of the department and has built a remarkable facility in downtown Toronto. With a team of nearly 40 full-time pathologists in a multi-specialty setting, and dozens of residents and fellows, her department reviews thousands of samples a week. Walking the halls where the doctors do their work, you might think you were in a law firm, except for the massive microscopes adorning each desk. The technology and organization were just about the opposite of what I saw in Argentina.
But it wasn’t the technology that was most impressive. It was the deep passion the doctors clearly feel about the art of pathology, and the prominence it must have in any realistic conversation about quality in health care. “Pathology has always been in the basement,” Dr. Asa told me, and she means it more than just literally. Most hospitals have their pathology departments in basements, where the space needed for big lab equipment is at less of a premium. But it also reflects the importance some place on pathology, almost treating it as an afterthought.
Back row, left to right: Dr. Runjan Chetty Director of Surgical Pathology, me (Evan Falchuk); Front row, left to right: Dianne Charmichael, President of Best Doctors (Canada) and Dr. Silvia Asa, Chief of the Surgical Pathology Department at Toronto's University Health Network
In creating her department, Dr. Asa set out to change all that. She convinced the hospital to put her department on the 11th floor, instead of spread among various empty basement spots. Having the department in one place, and close to other physicians, creates easy access and the opportunity to collaborate with specialists in the hospital. Day by day, she drives an appreciation of how important the art of pathology is to the delivery of high quality medical care.
Dr. Runjan Chetty is Dr. Asa’s Director of Surgical Pathology sees this in action every day. He worries that as medical education has become increasingly focused on clinical activity, an appreciation of the pathology of disease is being lost. Busy doctors have a tendency to accept the results of a pathology review as a given. But as treatments have become increasingly specialized to match specific pathologies, the importance of getting it right is greater than ever. And so treating doctors need to be more closely involved in understanding how these decisions are made. They need to engage with the pathologist, question the assumptions on which the diagnositc and treatment decisions are made, and help make sure the patient gets the right care. Dr. Chetty says that neurosurgeons are especially good at this, and you can sense how rewarding he finds it to have that kind of engagement with a treating doctor.
I hope to be able to write more about Dr. Asa’s extraordinary work in a future post. But what struck me at the beginning stayed with me at the end. More than 100 years ago, Dr. Osler instructed us to remember: “as is your pathology so goes your clinical practice.” Every day, Dr. Asa puts that lesson into practice, and does her important part in improving the quality of health care.
Disclosure: My company, Best Doctors, from time to time sends pathology to the Toronto General Hospital for review by its expert physicians. Dr. Asa consults for Best Doctors on related issues.
