各位老师讨论非常精辟，受教了！

目前国内开始实行3年住院医师培训，无疑是一大进步。可是有人嫌三年时间太长影响收入和生活质量，可以体谅他们的心情，在目前形势下也是一种无奈。

听说有些国家是有钱人才学医的？

 住院医师培训逐渐走上正轨，是件好事情。一定的年薪保证了医师的基本生活。

国内一直把病理学归属于基础学科，所以把病理学生归于一个比较尴尬的位置，这点我觉得迟早得调整。

病理研究生的培养也有一定误区，大部分院校都是科研型的，虽说是病理专业，但做的课题目前都是分子生物方向的，和病理关系不大。而且因为毕业发表论文的压力，病理研究生没什么机会看病理片的，越大的院校越是这样。结果就造成病理硕士博士毕业一张片子也看不了，惭愧的很。

希望病理住院医师培训规范化后能培养出真正适合做病理的专业人员，国外很多模式值得借鉴

 赵老师说的太有道理了

Of cause I know that many people will continue to study for master or PhD in pathology. This may improve the quality of pathology. However, Master or PhD study is more for sciense and research, not true clinical diagnosis.

1。目前在国内如果本科不是临床

那么读研出来的病理将没资格参加执业资格考试

2。如果读研期间专注于临床病理，那么毕业时将遇到硬指标：论文的限制

3。病理研究生，仅切片看得再好，都无法毕业；论文做的再烂，都可以毕业

目前上海实行的病理医师规范化培训似乎是个不错的制度

希望能广泛推行

做哪个领域不是最重要的，更重要的是要做好！

其实做哪个领域不是最重要的，更重要的是要热爱它、探索它、研究它、忍受它；而不是浮躁的利用它、不要有太多的功利心！

 要成为医生的医生，必须是一个称职的病理医生。水平应在良好之上。

在目前这个时代必须是形态＋临床知识＋免疫组化＋分子生物学=完整的病理诊断。

我的理解：形态－精益求精，知识－与时俱进＝良好的病理医生＝医生的医生。

目前若干分子生物学项目能收费，大家千万不能错过这个病理学科加速发展，经济上翻身的大好机会，高深的病理诊断＋良好的收入=医生的医生。

小平同志说过：贫穷不是社会主义。

同样：清贫≠医生的医生。

古人学问无遗力,
少壮工夫老始成。
纸上得来终觉浅,
绝知此事要躬行。

 世上没有救世主，需要的是自己努力， 所以就象金老师所说的，如果病理医生自己都不改变观念、都不去努力，别人怎么会这么认为。

病理医生的诊断就是指导治疗的，只是病理医生由于不跟病人打交道，病人不知道， 所以这种重要性没有被多少人认知。病理医生首先要做到的是你的诊断是正确的，多证明几回临床诊断是错的， 别人才服你。

中国病理医生的低收入是一种对知识的不尊重。在美国病理医生的收入不比内科，儿科医生低（不管是大学医院还是非学术性的医院）。但是一个领域的重要性不光是收入多少决定的， 造导弹和原子弹的那些人收入高吗？。 中国的一个问题是把某些科捧得过高，人都是很渺小的，心脏外科医生可能做不了脑外壳的手术。自己认为很伟大别人都不行的人，也成不了大师！只觉得自己的领域重要别人领域都不重要的人恐怕也成不了大师！

其实做哪个领域不是最重要的，更重要的是要做好！

北京市自2005（or 2006）年起，所有医生，包括病理医生，在考执业医师资格时，无论是本科毕业生，还是硕士研究生毕业，都必须经过3年的临床和医技各科的培训。然后才有资格考证。

有点模仿美国模式？一切都在逐步规范起来，这需要一个过程。

非常同意金老师所说的， “我国还有一个错误的概念：M.D.+ PhD 〉= M.D + 3年住院医师培训”。临床的东西是要做的， 看书是看不会的。即使在美国，只有MD学位和有MD+PHD学位的人所做的病理临床训练是一样的，不会因为你有PHD理学博士学位就不用做住院医生。以前美国的病理训练是5年（解剖病理+临床病理， 美国的临床病理就是中国的检验科）（如果光做解剖病理或者临床病理是3年），有PHD的住院医生可以只做4年，前几年给这个“优惠”也取消了，因为把病理训练（解剖病理+临床病理）时间改成了4年 （30个月的解剖病理+18个月的临床病理）。现在美国的病理医生找工作基本上都需要做专科训练1-2年了。

 举这几天的几例来说明一下我是怎么帮助临床医生的：

1：82 years old woman with diarrhea and weight loss for months.  I got her gastric biopsy which showed sheets of plasma cells.  I spoke to the GI doc and he said the stomach looks very nodular and funny.   I ordered giemsa and immunostain for H. pylori, both negative.  Did immunostains for immunoglobulin ligh chain gamma and lamda, and there was no light chain restriction.  These results basically exclude plasma cell dyscrasia.   The patient had a gastic biopsy 10 years ago and the morphology and immunostains of ligh chain were the same.  Anyway, i think she had RUSSELL BODY GASTRTIs.  I spoke to the GI doctor and he was clueless what i was talking about.  I briefly told him what it means and sent his some references to read.  I believe though this case, i educated this GI doc about RUSSELL BODY GASTRITIS.  He has been a GI specialist for 20+ years.

2.  Last Thursday, i diagnosed a GLOMUS TUMOR on a skin biopsy from forearm.  The 60 years old surgeon rushed to my office and said: are you sure?  I havn't seen a glomus tumor for 20 years!  I pulled out the slide and opened the book, the clinical presentation and morphology match perfectly. The surgeon was very happy.  Actually the patient and surgeon both thought it was foreign body because the lesion was very painful.  I have been doing pathology only for 10 years, much younger than the surgeon, yet i knew glomus tumor hurts like hell and the morphology was characteristic. 

3:  I gave a diagnose of RETE CYST of ovary to a senior OB/GYN doc.  She scratched her head and said" Gee, i have to go back to my books during residency".  I opened my book and showed her, it was a perfect match again.

I learn from clinicians.  But they really respect and trust us.  Today i got a breast biopsy with a note: please do FISH.  But the biopsy is pseudoangiomatous stromal hyperplasia.  I called the surgeon and told him  that.  He said: "The note is not from me.  I never order anything before i get a pathologic diagnosis".   I also explained to him that pseudoangiomatous stromal hyperplasia often presents as a mass.  He is happy to know that.

Today i had a ganglioneuroma from GI.  I faintly remembered from my residency time that ganglioneuroma can be part of a syndrome (Gardner's?).  I will read about it  and talk to the GI doc about this diagnosis.  Another day, i got 6 epidermal inclusion cysts from a 39 years old man.  I told the clinician that multiple epidermal inclusion cysts may be associated with Gardner's syndrome. He was glad to know that and he is sending the patient to see a GI doc.

The clinicians i learn the most from are ophthalmologists through corneal explants.  Many times i was clueless.  Then i call them ask why the patient had corneal tranplant.  The doctors always tell me the diagnoses with certainly.  One time, the eye doc told me it was a healed herpetic keratitis, another time it was MRSA infection.  THen i open my eye pathology book and match the pictures.  I have learned so much from them.