The boundaries of cellular pathology: how pathologists see their clinical role

There has been much recent public attention on the effects of the practices of cellular pathology on patients and their relatives. It is important to establish clearly pathologists' views about their professional relationships to clinicians and patients. A national postal questionnaire survey was performed to investigate how cellular pathologists perceive their role in clinical practice and whether there are important differences between different groups of pathologists. Responses were received from 773 pathologists, of whom 167 were trainees. On the basis of responses to 25 attitude statements, it appears that the profession shares a core belief that pathologists are clinicians rather than scientists and sees diagnosis as its main clinical responsibility. However, the role that each pathologist feels clear about differs significantly between pathologists, with a stronger consensus over function, responsibility, and professional image than on the clinical practice of pathology, job satisfaction, and the impact of technological change. Academic activities are a minority interest, although academic pathologists express better job satisfaction and more radical views of professional practice. Young trainees are more likely to work in teaching hospitals, to be female, to have trained outside the UK, and to have had experience in other specialties. They have, however, a more restricted view of the clinical role of pathology than accredited pathologists. Most cellular pathologists see themselves as clinicians with a special role in diagnosis, but how this is interpreted and the extent to which pathologists involve themselves in clinical decision-making is inconsistent. This professional dilemma should be addressed by research to obtain more systematic knowledge of the clinical impact of cellular pathology and especially the ill-defined links between diagnosis and clinical decision-making.