COVER STORY PathologyPathology 2025:2025: ImaginingImagining thethe futurefuture Never has medicine been as Dr Puay Hoon Tan technological advances and be fully involved in and direct new developments, challenging as it is in the 21st Singapore since it is only appropriate that century; and never have the pathologists be the ones to control the opportunities been so great. How will the role of pathology use of novel technology in our discipline to Pathology, as the very foundation of Q. change over the next two decades? improve patient care. medicine, is at the forefront of the revolution and new diagnostic tools A. In many institutions with a research Q. What is your wishlist for pathology and knowledge are taking arm, anatomical pathologists are already over the next 20 years? pathologists into broader roles of serving as the bridge between basic research and correlating diagnoses science and clinical medicine, and are A. I hope for sufficient pathologists to for clinicians. therefore poised to become effective perform the closely integrated duties of leaders in the research arena. I believe diagnostic service, teaching and research. Yet, despite the challenges and pathology will be increasingly called upon Pathology is the foundation of medicine, opportunities, there remains a to take a leadership or at least a and is by nature an academic discipline. It shortage of pathologists which adds prominent supportive role in research in is sad that pathologists have been to the pressures to this crucial the coming years. sometimes relegated to a less important branch of medicine. So, what does It is hard to clearly imagine what role in the medical profession. The goal as the future hold for pathology in advances in information and other an anatomical pathologist is to provide as best a diagnosis on submitted tissues, and 2025? PathWay asked five leading technology will have exploded into our lives by 2025. It is difficult to use to be an effective member of the pathologists from across the globe pathology of 20 years ago as historical managing team of clinicians in solving the to share their vision for the future, comparison with pathology today, and problems of patients. In order to achieve with some fascinating and extrapolate the advances over the past 20 these aims, pathologists should constantly surprising results. years to the future two decades, as the add value to their work by actively pace of development and change will be participating in teaching and research, as distinctly more rapid in the future. these are efficient means of learning, Hopefully, pathologists in 2025 will not be understanding and self-improvement. This merely “tissue samplers. Pathologists wish can only be realised when there are need to keep pace with current enough pathologists on board. 6_PATHWAY I truly hope that pathology can be re- Sir James Underwood as exciting as forensic death established as the basis of all medical investigations. disciplines, and regain the respect, United Kingdom Research in pathology should be relevance and profile within the medical valued by its benefit to human health and community. It is also important that more Q. Which scientific/technological/ welfare rather than by the size of the young medical professionals should medical developments will have the consider pathology as a viable career most impact on pathology in the research grant or the impact factor of the option, as that will be the start of coming years? journal in which it is published. alleviating the current shortage of When given death certificates, pathologists. There is a great need for A. Advances in genetics, information bereaved relatives should ask certifying pathologists with passion for the technology and digital imaging are already discipline. transforming histopathology and many doctors how they can be so confident Technological advances should be other pathology specialties. This will about the cause of death when research harnessed to continually improve the continue. In histopathology, for example, I shows that up to 30% of certificates are discipline, with the pathologist in charge. predict that much interpretive reporting will significantly wrong or incomplete? How be done from flat screens rather than about an autopsy? through microscope eyepieces. Q. Where would you like to see Pathology services should cease to be research focused over the next 20 years? In my specialty of histopathology, I forecast that molecular pathology will regarded as a ‘cost’ or ‘overhead’ in A. I would like to see research focused develop alongside diagnostic macroscopy healthcare organisations. on cancer prognostic markers and cancer and microscopy and as an adjunct, rather Pathology investigations should be than as a substitute. cures via targeted therapies. Advances in evidence-based in order to reduce molecular taxonomy will be an important unnecessary tests and iatrogenic anaemia adjunct to histologic diagnoses. How will the role of pathology Q. (resulting from excessive haematological Development of dedicated tissue banks, change over the next two decades? construction of tissue microarrays, and biochemical investigations). standardization of processing protocols so A. Pathology will always to be the that paraffinised archival tissue can be scientific basis for medical practice, but it Q. Where would you like to see effectively harnessed for will continue to struggle to get this research focused over the next 20 immunohistochemical and molecular message across to curriculum planners years? research, all occurring within an and to health service managers. established ethical framework that ensures The migration of some pathology A. Rather than suggest topics for moral standards, will be in the future of ‘tests’ from laboratories to the point-of- research, I would argue for a cultural shift research pathology. care will continue, but hopefully with concerns about training, health and safety, in how pathology research is designed, Q. If the current shortage of quality assurance, and results conducted and published. Too many pathologists continues, how will the interpretation fully addressed. This will be papers report small series with numerous profession and the community be best achieved by point-of-care testing variables, such that the study is incapable affected? being part of a locally managed pathology of advancing knowledge with sufficient network. reliability. To give pathology research the A. The profession will not be able to pull Medical graduates (as opposed to status it deserves, we should encourage itself out of the monotony of service work, science graduates) working in pathology studies that are robust, powerful and and will not find time to participate in services will continue to develop a much value added activities such as cutting more patient-centred approach to their demonstrate clinical effectiveness. For edge research, which will be taken over by specialty, with increasing involvement in example, a new classification or grading of non-pathologist scientists. The discipline clinical decisions as members of a particular disease should be researched will be unable to improve and advance. multidisciplinary teams. as a clinical intervention in order to There will be a pervasive low morale which determine the effect on patient outcomes. may cascade into a vicious cycle with Q. What is your wishlist for pathology diminishing numbers of young doctors A new monoclonal antibody for identifying over the next 20 years? being interested in the discipline. It will histogenetic or predictive markers should continue to slip in professional standing in A. Pathology should be restored to its be evaluated for its actual clinical utility. relation to other more glamorous and rightful place in the medical undergraduate Sir James Underwood is Professor of Pathology dynamic medical disciplines. curriculum before widespread ignorance at the University of Sheffield, UK, and and misunderstanding imperils patients, if consultant histopathologist to the Sheffield Dr Puay Hoon Tan is the Senior Consultant and Teaching Hospitals. In 2002, he was elected Head of Histopathology at Singapore General it has not done so already. Hospital and Adjunct Associate Professor President of the Royal College of Pathologists. Departments of Pathology and Anatomy, Television drama producers should He was recently knighted for his services to National University of Singapore. realise that cancer diagnosis can be just medicine. PATHWAY_7 COVER STORY saying this for years and it won’t happen Dr Lee Hilborne Q. If the current shortage of over the next 20 years. I am not sure how USA pathologists continues, how will the fast change will occur. Of course, if the profession and the community be demand for pathologists rises and the affected? Q. Which scientific/technological/ shortage increases, the laws of supply and medical developments will have the demand will necessitate that the cost of A. Pathologists, laboratories and diagnostic activities will be predominantly most impact on pathology in the professional pathology services will located in major population centres with coming years? increase and more individuals will be point of care testing, courier transfer of encouraged to enter the profession. A. Molecular diagnostics, genomics and specimens and electronic communication proteomics will probably have the biggest Current trends have been in the opposite of results. This has already happened with impact because they will continue to direction, but shortages will force