Hidden clinicians

Many patients take great care in choosing their specialty care doctors. Yet, how many patients give consideration to the pathologist reviewing their biopsy specimen or the laboratory to which their samples are directed? Pathologists are the hidden clinicians, often working behind the scenes. Although pathologists have always been direct care providers, most do not come face-to-face with their patients, Yet pathologists help guide most diagnoses and treatments through microscopic evaluation of tissue specimens and interpretation of clinical or molecular laboratory tests, including for precision medicine. Undoubtedly, most anatomic, cutaneous, and oral pathology practices experienced a dearth of specimens during the early months of the pandemic. When much about the virus and its transmissibility were still unknown, health care practitioners’ offices and most outpatient practices in hospital settings were closed owing to governmental “stay-at-home” orders. However, in many institutions, continued care for medically complex patients remained a high priority, and cancer care and diagnosis continued almost without skipping a beat. In my own practice, there were several days during which cancer was the only diagnosis I reported. However, our collective impact on patient care is likely not known or recognized by the lay public or policy makers, let alone our own students and colleagues. In an era when teaching of histology and basic histopathology has mostly disappeared from educational curricula, and when students often regard their learning of pathology as a means to an end to pass national board examinations, medical and dental students are graduating without understanding the essential role of pathologists in patient care. Moreover, as technologies evolve, particularly in artificial intelligence and machine learning, and laboratories seek to further automate, I believe that the pathology profession as a whole faces challenges that must be addressed to ensure its continued growth and to reinforce the value of this unique specialty in clinical decision-making to a future generation of students and practitioners. Although pathologists may be hidden clinicians, being visible and available to students and colleagues may be the easiest way to ensure a continuous pipeline of dedicated trainees and to ensure greater understanding of the essential role pathologists play in patient care. Moreover, although pathologists may be hidden clinicians, we should be contributing as drivers in the development of diagnostic technologies rather than simply being reactionary and accommodating to new technologies. Hospitals and other health care institutions around the world have had to adapt and readapt in ways that were unimaginable just 2 short years ago. Health care providers and their support staff have been on the front lines since the very beginning of the coronavirus disease 2019 pandemic. Without exception, they deserve the credit and appreciation they have received. However, I would argue that pathologists were and continue to be among the unsung heroes of the pandemic. Oral pathology is only a small cog in the pathology “wheel.” Yet, our profession can offer a great deal of expertise, data, and value, especially as it relates to the recognition and mechanistic understanding of oral disease. The pandemic has afforded us potential opportunities to consider reshaping how we characterize our own collective philosophy and scope of practice. As just one example, how many of us previously gave much thought to the role we may play in not just advocating but actually administering vaccines including the human papillomavirus vaccination? Although we may be hidden clinicians, I believe it is long overdue for oral pathologists to come out from behind the curtain and get a visible seat at the table. To do so, I believe that we need to better organize and pool our efforts without regard for borders to maximize the positive impact we can have in helping to shape policy-making discourse. In my opinion, this should be an aspirational goal of organized oral pathology.