Re: Russ, Ian what's the scoop on Path/UK/DX/errors?
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|From:||RUSS ALLISON <Allison@Cardiff.ac.uk>|
|To:||Sarah Christo <email@example.com>|
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
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
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,
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