BeST
"You must always do your BeST to be a good pathologist."
—Dr. Ro
Besides the literal meaning of best, we have our own "BeST." The "BeST" stands for "B" representing "Basics", "e" for "enjoyment", "S" for "Study" and "T" for "Think".
Basics:
The art of pathology is observing and diagnosing tissue or cells that are abnormal or diseased. Obviously, it is impossible to do this without knowing what "normal" looks like in the first place. Dr. Ro often repeats his favorite mantra: "You must study basic histology!" This is usually said after one of his residents confuses breast tissue with prostate, or skin with mucosa. It is an obvious truth that a solid foundational knowledge of basic normal histology is one of the keys to becoming an excellent pathologist. A diagnosis of "no pathologic alteration" (i.e.- normal) is often harder to make than a diagnosis of carcinoma. A pathologist who is well acquainted with histology and all of the unusual variations of morphology that may be seen in "normal" tissues will more easily be able to discern normal from diseased tissue.
enjoyment/enthusiasm:
Although it is not strictly necessary to enjoy pathology, it is the defining feature that separates good pathologists from outstanding pathologists. The difference is obvious in the academic setting, where those who are enthusiastic about their work are effective teachers and admired mentors. These pathologists inspire their pupils to learn more, to work harder, and to enjoy the study and practice of pathology. As with any vocation, those who enjoy their work will perform better and have increased job satisfaction. Enjoyment and enthusiasm help to make the sacrifices worth it, make it easier to stay late when necessary, and keep one from exhaustion and burnout. If pathology is not enjoyable, then why do we do it?
Study:
Dr. Ro repeatedly admonishes his pupils to study in addition to attending his daily teaching conferences. It is often difficult to balance reading and studying with other demands such as service work, research, sleep, family, etc. Yet pathology is such a diverse and vast body of knowledge that it requires constant reading of the literature as well as textbooks. Reviewing slide study sets or image banks is also a very useful tool, especially for residents, fellows, and junior faculty. It is important to see as many different entities and morphological patterns as possible in order to hone pattern recognition skills. An excellent pathologist, however, goes beyond mere pattern recognition by reading to acquire better knowledge of the etiology, pathophysiology, and epidemiology of each disease process (see below). When a senior pathologist mentions that he still learns something new almost daily, even after 40 years of practice, it serves as a poignant reminder that there is never an end to studying.
Think:
Pathology is more than pattern recognition and memorization, although certainly those skills are necessary to be an excellent morphologist. As mentioned above, a truly excellent pathologist will not only recognize a disease by its morphology, but will understand the disease and how it behaves because she has studied. The role of the pathologist is not merely that of a diagnostician but rather that of an information analyst, who takes all available case data (clinical, radiological, histological, immunohistochemical, molecular, etc) and arrives at a logical, clinically relevant diagnosis via critical thinking. If one stops to think, one can hopefully avoid the embarrassing situation of rendering a diagnosis that defies common sense. Thinking before ordering immunohistochemical stains may save the patient thousands of dollars and save the pathologist from "staining himself into a corner" when unexpected and confusing immunostaining results must be somehow explained. Critical thinking is also a necessary tool in evaluating the literature and is needed to "separate the wheat from the chaff." One should not believe a textbook or even a respected mentor without first thinking about the reasoning behind any given statement. Thinking also provides job security, as a thoughtful, critical, clinically-minded pathologist is an invaluable asset to her clinicians and her patients and less likely will be replaced by a lower cost alternative that merely provides a diagnosis. Along the same lines, thinking is essential when composing a pathology report or consult letter, as those written documents are intended to clearly and effectively communicate and transmit information to the clinician. Even if spelling and grammar are correct (which is an absolute requirement), slight variations in wording or syntax can mislead or misinform the reader. A truly excellent pathologist is a thinking pathologist.
—Jae Y. Ro, M.D., Ph.D. and Jerad M. Gardner, M.D.; 2009 [1]