Pero, ¿qué es un patólogo?

Have you ever had a cytology or have you had a biopsy? If so, surely this has caused some concern until your doctor has said: "Do not worry, it is benign and has treatment," or "No problem lady, your cytology is benign and your problem is inflammatory, I will put a treatment and it will recover soon ". And you, have you ever wondered how your doctor knows so safely?

You probably think that, in these times of such prodigious medicine, it is a highly sophisticated machine that analyzes your sample, your cytology or your piece of skin for example, and issues a result on a paper similar to your blood test.. Well, nothing is further from reality, its "result", which we should call better "diagnosis", is done by a specialist doctor that you will probably never know (he would be happy to greet you instead) but that, nevertheless, he may play an essential role in your life since you will be responsible for your diagnosis. That doctor is the Pathologist or, if he prefers in the official terminology, the specialist in Pathological Anatomy (also called "antomopathologist").

Maybe he asks: "... And who is this gentleman? What does he do? Where is he hiding?" The pathologist is the doctor responsible for something as serious as deciding what his illness is , whether it is benign or malignant, if the treatment applied by the surgeon is appropriate or not, if the margins of resection of a tumor are safe or not and to guide the treatment in many cases or to know how he has responded to it. For this, the Pathologist in his office examines his cells and tissues under a microscope to find out what is happening to them, what injuries they present in order to, little by little, reach an opinion on what his disease is, what is his diagnosis. As you can see, it can not be further from a machine, it's just the opposite. The pathologist, personally and case by case, applies his knowledge and experience to examine his tissues and look for his alterations, which are responsible for his illness and elaborates his diagnosis without more help than his own medical knowledge and his skill and experience at the time of seeing diseased cells and tissues under the microscope. This specialty has been in the world for many decades, in Spain since the mid-60s of the last century, but in other countries it is already centenary. In this century, of spectacular medical advances, this work may seem anachronistic, even risky without the technical help of sophisticated computers, image systems or the Internet, but it is like that, and from the first moment knowledge has been and is the basis of pathologist's work. In fact this is a difficult specialty to learn and practice but do not worry, the pathologists act with a narrow margin of confidence, or what is the same, with great reliability.

Maybe you're wondering: how do you do it ?, what do you look at the microscope? Well, in principle the answer is not very complicated. To be able to examine the cells under a microscope, in the case of cytologies, the examination is direct because the cells are in the extension prepared by your doctor or this is prepared in the laboratory by simple techniques, for example in the case of liquids bodily. In the case of biopsies, it is somewhat more complicated since very thin sections must be obtained to allow the passage of light through the tissue and the tissues are opaque and if thin sections are not obtained (4 to 5 thousandths of a millimeter), no can examine through a microscope. In both cases cells and tissues must be colored with color products since they lack their own color, they are transparent. All these processes are carried out in a special laboratory, very different from the classic laboratory of clinical analysis that you surely know, but this part of the work does not the pathologist but the Technicians of Pathological Anatomy that, with its inestimable work, that requires training, experience and responsibility , are those who perform the preparations that the Pathologist examines. When the laboratory has finished preparing the samples, they are passed on to the pathologist to be examined and this is where their work begins. The diagnostic process begins. The pathologist submits the laboratory preparations to a systematic, patient and rigorous observation of each and every one of the preparations that the technicians have given him, looks one by one at the lamellae, points out what he sees, requests more techniques if he considers it necessary ( of that is spoken in the following paragraph) and elaborates its diagnostic conclusion, that is, it answers your question: what illness do I have? On many occasions consult bibliography to document their findings and often consult the case with a colleague who is an expert in his pathology if he has the slightest doubt. In a way, it anticipates your request for a second diagnostic opinion and, in fact, in some countries, not yet in ours, some diagnoses of tumors, such as melanomas, must be signed by more than one pathologist. .

Over the decades in the field of biology, techniques have been emerging that have improved the study of cells and tissues to the extent that, nowadays, it is possible to obtain information on the biochemical and molecular properties of tissues, their genes and chromosomes and, even, the existence or not of genetic alterations that may be present in some diseases. The application of all these techniques is of great help for the Pathologist, and therefore for the patient. How can the pathologist take advantage of all these advances? The answer is that in very different ways but always the pathologist ends up observing the findings of all these techniques under the microscope. For example, pathologists can make visible the hormones that a certain tumor makes or they can also make visible some important chromosomal alterations under the microscope to establish the diagnosis or plan the treatment in some tumors, for example, in breast cancer.

In this way the pathologist has become one of the pillars of modern medicine, is responsible for many of the diagnoses made in a hospital and of course all those that are important, such as cancer. Every sample removed from a patient is sent to the pathologist to dictate its nature. Despite this, the vast majority of patients do not know of their existence and even less of their work, but what are we going to do, in these times knowledge, the basis of our specialty, does not always find the well-deserved reward. But do not worry, never forget that behind the diagnosis of your biopsy, your cytology or the piece of your operation is a trained and responsible professional, a Pa tólogo, whose motto will always be "Working for the safety of patients".