THIS week Dr Zak talks about the support network behind our GPs.

THERE is a common conception among many, often perpetuated by doctors themselves, as to how the various members of the medical profession will appear and behave.

The surgeon is the bad tempered meticulously tailored hero who aims to line up every stitch perfectly without losing a single drop of blood in the process.

The general practitioner is the affable, comfortably attired first port of call, assessing each patient at the start, treating those that can be, and referring others who require more specialist input.

While these may be generalisations, they’re sometimes not too far from the truth.

Yet pathology often conjures up images of solitary figures in blood-spattered plastic aprons, performing autopsies in the middle of the night, dictating their findings impartially into an overhead microphone, while the attending police officer looks on anxiously.

In fact, forensic pathology, as described in a somewhat tongue-in-cheek manner above, is only a small aspect of a field that encompasses 18 different specialties. Although autopsies aim to investigate the cause of death, the vast majority of pathology and its workload is for the benefit of the living.

Pathologists are often called the doctor’s doctor, because they are the specialist other doctors turn to when they need answers to the nature of a disease as well as its likely outcome, which in turn guides treatment.

Not a single cancer diagnosis is made without the input of a pathologist. Although the GP may identify a symptom of concern, and the surgeon may remove the abnormal tissue, it will be the pathologist who will confirm whether it is benign (good) or malignant (bad).

Indeed, as well as body tissue, every single blood sample and bodily product including urine, semen, sputum and faeces will be analysed in a pathology lab (“path lab “). In the current pandemic, these labs are processing the all the COVID swabs, to keep the nation safe.

That’s not to say that pathologists aren’t involved in direct patient care. Haematologists (blood doctors) treat patients with disorders such as anaemia, as well as primary blood cancers, for example leukaemia. Their commitments include outpatient clinics, inpatient wards and they will often be called upon by other specialties. When a surgeon is struggling with a bleeding patient in theatre, they may ask the advice of a haematologist. If a major trauma comes into the Accident & Emergency, it is likely the receiving team will ring the on-call haematologist to guide their use of blood products.

Pathologists, like GPs believe that prevention is better than cure. Screening programmes for example that for cervical cancer, rely on all smears being looked at under a microscope to identify any abnormalities which mean the woman needs smears more regularly, or that she needs to be referred to a gynaecologist for further treatment. Equally normal smears provide reassurance to hundreds of thousands of women every year.

On the same lines, clinical biochemists will be involved in the diagnosis and management of patients with high cholesterol levels, so that these can be treated with the aim of reducing the person’s risk of a heart attack or stroke.

Pathologists are as much involved with the start of life as they are at its end. When a couple struggle to conceive, they will be referred to an obstetrician. As well as physical examinations and scans, semen analysis and blood tests will be needed. A reproductive scientist will be part of the team that not only investigates, but also treats infertility or subfertility.

Medical microbiologists are pathologists trained in the study of disease caused by bacteria, viruses, parasites and fungi. They advise on the appropriate use of antibiotics, a vital contribution in an era of multidrug resistant organisms. In the event of an outbreak of infection, they will be the first to be consulted.

Certain TV series have given the idea that pathologists aren't good communicators. However, as they routinely write reports upon which vital decisions are made, they are usually among the most eloquent of the medical community.

It is not uncommon for pathologists to be central to the provision of education for medical students and junior doctors. Their broad spectrum of knowledge and training allows them to talk about multiple aspects of medicine, not just pathology itself.

Pathology, and indeed the medical profession as a whole, relies on the associated technicians and indeed every healthcare professional involved in the journey from taking a sample, through to it being analysed and formally reported.

This week is National Pathology Week and I'd like to take this opportunity to thank all of those, especially the unsung heroes, in this diverse and marvellous field. We literally couldn't do the job without you.

Dr. Zak Uddin

General Practitioner

MB ChB, MRCS, DRCOG, MRCGP

website - www.doctorzak.co.uk

Twitter - @AskDoctorZak