Good spot Sarah!

The Health Service is constant news in the UK (as elsewhere, I 
guess), mainly because it is almost always "bad news".
The particular case involved a retired histopathologist who was 
doing locum work and had reached the grand old working age of 78 
(yes, seventy-eight!) when the problem you've read about surfaced.
He had lost his ability to "call it".  Of course, we have no idea on 
whether he ever had that ability.

His reports must have been called into question for some reason; I 
have not read why, and led to a formal review by the Royal College 
of Pathologists which found numerous "mistakes", including non 
ca's being called ca and vice-versa.  These included primary beasts 
and positive nodes at excision, for example.  200 cases in all.

Our system of laboratory accreditation (Clinical Pathology 
Accreditation (UK) Ltd - CPA, equivalent to your CAP inspections I 
guess and an anagram of that acronym [I've been dying to write 
anagram of acronym] - are you still with this sentence? - demands 
one pathologist for every four thousand cases the lab receives.  A 
somewhat arbitrary figure, you may think.

However, there had been a huge cut-back in histopath training 
posts some years ago and, of course, it is impossible to recruit 
skills which are not in the market place.  Ergo, a shortage of 
pathologists.  Ergo, the use of locums.  Ergo, shortage of retired 
old guys (sorry Don) to fill these posts, Ergo, this particular old, old 
guy.

Are you following me so far?

The Quality Assurance (and quality control)  schemes you refer to 
are, I assume, those currently being advocated for histotechnology 
in the USA?  If so, they are "technical" External Quality Assurance 
scheme(s), which in the UK have probably raised standards (even 
higher) of the "histotechs".

Diagnostic Quality Assurance is much more difficult in 
histopathology.  First, there is no absolute certainty of the 
histological diagnosis.  If the same section is sent to 100 
pathologists and 99 call it one thing, you have no certain way of 
knowing that the guy (or gal) who calls it something different is 
wrong!

Of course, Joe public (even when identified as my closest relatives 
and friends) cannot understand that.  It is not an exact science, but 
people who look down the mic. are expected to unerringly 
recognise the disease correctly.

However, there are QA schemes, based on "common consent" 
diagnoses.  Send the same case to fifty pathologists, if all agree 
on a diagnosis, the chances of it being the right one is very high.  If 
five different diagnoses are reported, the case is a "difficult one".  If 
forty-nine call it one thing and one something else, the chances are 
(s)he got it wrong.

Pathologists may be unhappy with that, but Joe Public has a better 
chance of understanding it and would undoubtedly go along with 
the majority vote if it was his prostate!  (makes a change from "her 
breast", eh guys?)

Anyway, that is the scheme that is gaining wider support.  It 
features periodic "get togethers" to discuss the cases.

Of the wider picture, there is NO limit to the amount of money that 
could be spent on health services.  In the UK, the NHS is in a 
mess, entirely of its financial making.  Successive governments 
have tried to make more cash available by cutting costs, 
"increasing productivity". etc.  It is my belief that unfortunately the 
government still feels that one way to improve heath care and 
increase resources is by "greater productivity".

Unfortunately, heath service staff have been told for decades now 
(REALLY - DECADES), that if they "increase productivity" the 
rewards will follow.

They have not!

Staff are fed up with waiting, are demoralised, have retired or left, 
are dispirited and disgruntled and no longer co-operate.  You will 
continue to read of disasters.  Just hope you are not involved.

And that's me, upbeat Russ Allison, who loves his job and believes 
passionately in the NAtional Health Service saying all that!

Sorry if I bored you,


Russ Allison, 
Dental School
Cardiff
Wales