What does a pathologist do?

In medicine, the specialty of pathology is defined as the study of disease.  Pathology is the broadest of the medical specialties because it involves study of the effect of all diseases on every part of the human body.  To become a pathologist one must first obtain a college degree and then an MD degree.  After receiving an MD, the doctor who chooses to become a pathologist must complete a residency in the specialty of pathology, taking three or four years, depending on whether she opts to become an anatomic pathologist, a clinical pathologist, or both (four years for both, three years for either alone).

In pathology residency the doctor must first learn the gross (naked eye) and microscopic (tissue samples on slides viewed with a microscope) appearance of every tissue type in the human body.  Only after this is accomplished can the doctor then begin to learn to recognize the effect of diseases on these tissues.  When he has mastered this activity, the pathologist becomes able to diagnose disease by examining tissue removed from the body (at surgery or by biopsy), both grossly and under the microscope.  The examination of tissues removed from the body is called Surgical Pathology.

Pathologists also perform autopsies, removing and dissecting the organs from deceased patients in order to determine the presence and severity of disease.  A subspecialty of autopsy pathology is Forensic Pathology in which autopsies are done for cases involving the legal system for the purpose of determining the cause and circumstances of death.  Coroner offices or medical examiners do forensic autopsies, usually when death is unnatural (accident, homicide or suicide).

Another important branch of pathology is Clinical Pathology.  This involves studying  the effect of diseases on the patient’s blood or other bodily fluids.  When a person goes to the medical laboratory to get a blood test, a clinical pathologist medically directs that laboratory.

In addition to the above, there are other subspecialties in pathology such as blood banking pathology, neuropathology, and pediatric pathology.

A Forensic Pathologist spends most of her time doing autopsies.  She is occasionally called upon to do death scene evaluations, and must testify in court about her autopsy findings in homicide and wrongful death cases.

The hospital pathologist is usually certified in both anatomic and clinical pathology.  He has an office in the hospital and directs the activities of the hospital laboratory.  He examines and diagnoses all organs removed from the body during surgery.  He attends staff meetings, and acts as a go-between for the treating physicians and the clinical laboratory.  He is available to go to the operating room on short notice to perform a frozen section for rapid diagnosis when something unexpected is found during surgery.

In summary, a pathologist is a physician trained in diagnosing disease by examining body tissues and fluids.  He does not ordinarily treat patients himself, but assists the clinical doctors in doing so…acting primarily as an expert consultant.

The first reference below is an article from a medico legal web site that I authored years ago on how an attorney should choose a pathologist as an expert witness.  It gives a comprehensive explanation of the branches of pathology and the training of pathologists.

The second reference gives the definition of pathology, including all of the many sub-types of pathologist.