诊断: 症结就在于 pathology as an important medical discipline is misclassified in China。

I agree with many points made by  “不能考执业医师的病理研究生们都来看看”.  In fact, “病理研究生无法报考执医而从业” is only one of the major challenges facing pathology and pathologists in China.  There are several other related issues and serious challenges.

I.   症结就在于 pathology is misclassified in China。In most part of the world, including U.S.A, pathology service belongs to one of key clinical disciplines! But pathology diagnostic service in China is classified as “second class, auxiliary” clinical discipline. 

The inappropriate classification of pathology in clinical disciplines determines the social-economic status of pathology and pathologists.  As a result, the misclassification of pathology causes subsequently three key problems, among others:

(1)    The status of pathology service is not well respected by other “major” clinical services. 病理学科在疾病的诊断和治疗中的关键作用有目共睹. Pathology diagnosis is the gold standard! But in China, only when a malpractice happens, people (the CEOs, presidents of the hospitals) realize the importance of pathology. Otherwise, not much attention is paid to pathology. 病理科是不讨好的科室. Pathologists are just humble “grandchildren” in the hospital. 病理科 often time has  small work spaces, unfavorable locations, and very limited resource allocations of the hospital budget.

(2)    病理医生低收入. In USA, pathology is very competitive medical discipline, and pathologists in USA are paid reasonably well compared to other clinical disciplines! One of the main reasons is that the pathology diagnostic service fees in USA consist of “professional component (about 70%), and material/instrument component (about 30%)”. But in China, the services fees consist mainly of material/instrument component. We need to change this: pathologists in China need to get higher salaries!

(3)    Because of the above 1 and 2,  中国病理人才越来越少，病理学科的发展停滞不前. A lot of young students with interest and knowledge of pathology are ending up doing something else!

I have visited more than 80 Chinese hospitals/university medical centers since I practiced pathology in U.S.A in 1999. There are significant shortages of good dedicated pathologists in China. Many places re-hired retired pathologists/professors since talent young medical students want to do other medical disciplines rather than pathology because the above problems. As a matter of fact, the situation was not the same when I was studying pathology in China in early 1980. At that time,  pathology service was still considered as a clinical discipline as other major medical disciplines and many dedicated medical graduates chose pathology as a career.

II.  In summary,  new policy should be considered to address problems of pathology in China.  New policy should be discussed, planned, tested, and implemented based on three major aspects, namely professional input, international standards, and the demands from the society!!

(1). Professional input, as stated in the above, is already very clear.

(2). International standards are also easy to check via web, international pathology organizations, and international pathologists including myself.

(3). The demands from the society, from the patients, are very high. China has transformed significantly during the past 30 years.  For example, China now has the best 5 star hotels, best high-speed trains, and best shopping malls. That is wonderful. But pathology services have not been improved during the same period of time. In fact, they are becoming worse.  China, and Chinese people need the best pathologists!! Chinese patients need to enjoy the best quality of pathology diagnosis services!!

III. We need to work together to solve the problems. Each and everyone of the pathology community have the responsibility and duty to respond to the problems. We need every 病理医生积极主动参与的热情. The following are major suggestions:

            (1). To mobilize all national and local pathology organizations. It is very important to act as a massive group, with a stronger voice! To mobilize the media: newspapers, websites, radio and TV stations. Huaxia Pathology website is a very useful platform. To unite organizations of other medical disciplines, which are relied on pathology services.

            (2) To address the issues one by one directly: namely RECLASSIFY PATHOLOGY DIAGNOSTIC SERVICE AS A MAJOR CLINICAL MEDICAL DISCIPLINE!! SO IT WILL promote the social-economic status of pathology service and pathologists among the professional field of medicine.

            By doing this, the whole landscape of pathology will change: more and more people will do pathology, more and more resources will be allocated to pathology services and pathology research. The final mission of medicine, serving the patients well, will be accomplished. However, these all need the involvement of pathology organizations and every pathologist. Everyone can make a contribution to this effort.

            To address the problem of 病理研究生无法报考从业,  it also needs to 制定一个严格的完善的准入、管理体系, 准许病理研究生直接参加医师考试. But 病理研究生 still needs to be trained for additional years before being allowed to sign out pathology diagnosis report.

为发展中国的病理事业, 为病理学科后继有人，Let’s work together！

I certainly will try my best to contribute to this long-term project.

谈东风   May 27, 2010 from Houston.

病理学归到基础医学，无疑漠视了病理学科的特殊性，现如今，为病人服务的检验，麻醉，影像等专业都归到临床医学，而病理，目前真可谓是鸡肋学科，领导们，这种现状何时扭转？病理专业被基础这个大帽子扣着你们竟毫无作为？这顶帽子什么时候摘除？

 谈老师的文章直面现今国内病理医生的处境，真希望病理学能得到一次彻底的改革和翻身，

我也曾经设想假如我们全科人民罢工一周，一个月，那么我们医院必将瘫痪！！！

 主要原因是，干病理的人少，也不团结，而且大多数人不管在这如何陈词激昂，能团结一致的站出来的有几个？有的大医院的同行还看不起基层同行．记得在一个会上，某大医院女博士说基础诊断水平太低应该解散，让大医院来看．真的很牛，是不是觉得中国就几个病理科你的收入和地位就上去了，太目中无人，也太无知了．基层医院的医生学历是低，但学历只是说明你一方面的问题，说真的干病理的那个不知道，会考试的不一定诊断水平高，下面病材是少，但基层病理看片子的悟性不比三甲医院的医生差，这点看看三甲医院里基层的进修医生就知道，下面牛人也是辈出的．别人把你分成下等，你自己再给自己分个三六九等，不可笑吗？现在一开会就某博士，某名医院，仿佛基层医生是透明的，自己都看不起自己人还指望别人尊重你？每个人在自己的位置上都是要付出的，都不容易，不要因为自己所在位置而对别人不屑，什么都是暂时的，我们的位置也是．如果大家能，相亲相爱，同声同气，团结一致，相信病理人的力量会更大更强．

另外病理人还在心里觉得自己的科室是为临床医生服务的，没有觉得自己是为病人服务，不能怪别人把你划为辅助科室．现在国内病理的临床相关性太弱，其实应该有病理医生参与定期临床查房，讨论病人治疗方案和判断预后．其实病人非常希望对自己的病有一个清晰地认识，病理人的专业知识对病人了解自己的病很有用，这些知识是临床医生的弱向，也是我们的优势．病理如果只是单纯看片子，搞研究，来了个病人只是一味地发单子了事，不想办法如何积极和病人接触只是一味和临床医生打交道，甚至还要为临床的一些失误擦屁股，光指望别人给你地位，如何能找到自己的一席之地？想在医院这个舞台上有地位就要和病人多接触．

经济基础决定上层建筑，收费的确是很关键，病理人的技术比耗材才低，这本事就是对病理人的侮辱，试问我们的智力和技术劳动还比不过那些机器和耗材吗？不管收入多少，这种价格的低廉就是对病理人的轻视．所有病理人都应该积极的不断的通过各种途径抗议．．．．．．．．．

无名小辈，一家之言，欢迎指正．

影像学最高一项收费1万多，还很少承担看对看错的责任；病理收费几十年如一日，一个诊断几十元，收费上不去，金标准就不值钱！不赚钱在医院就没有地位，奖金不高，家庭生活质量就难以保证。

现在不仅病理医生很多流失改行走了，各个病理诊断公司又不停地从各级医院病理科挖人，再加上病理医生的培训期很长，没有5年的工作经验，都很难独立担当，这些都导致行业病理医生的严重缺乏，病理科青黄不接；病理行业的不景气，导致一些病理商家也改行不做病理产品。

再不彻底变革，这个行业萎缩的更快了。

 这些需要学会的力量，还有病理必须分为临床病理和基础病理，否则发展不乐观。现在这个状况是不尊重知识的体现！

在美国一个病理报告读片的收费可以超过外科手术的费用！

还有病理诊断：不是学位高就能诊断好的，很多时候学位和工作能力是两码事！现在最大的问题是如何解决基层病理医生的培训问题。

个人不太支持病理分为基础病理和临床病理，现在基础病理很难有吸引力，干脆就叫临床病理学或者病理学，直接归入临床医学范围，病理不和临床病理诊断紧密结合，很难是像样的病理。省得相关学生被限制从业，受到歧视。

当前中国的学历教育问题很大，官僚作风严重，改革不到位甚至没有改革，真不知道管理层整天在忙些什么。

如果很多问题不提到日程，花大力气解决，提高病理收费和提高病理医生的待遇和地位，将永远只是口号而已。

 楼上说的对。

其实我一直觉得，国家不是说在提高准入，而真正的是否定病理学科的临床地位，一个学科划分那么早，而当前的医师法却限制病理考，一个大帽子就是基础，这样的教条思想根本就是藐视病理学科的存在，这个还用争论吗？明摆的事。

个人从来就觉得，干不干好什么，跟个人的努力奋斗程度有关系，大专都能考，病理研究生不能，为什么还说在提高门槛，不觉得可笑吗？

我们这些学子要高调起来，对于不平等的政策，我们要大声说出来，说出咱们的道理，说出咱们的自信，咱们不能一味的请求，而失去尊严和自信，咱们要勇于挑战管理部门的思维定势，迎接挑战，自信的说出自己的能力，上层如果质疑我们，我们应该要求上层考核考察，一切想当然的思想，都是不可取的。我想对兄弟姐妹们说，一定要坚持，一定要有决心，有信心打这场战役，解禁是我们的终极目标，这个永不可动摇。

 感谢所有力挺的老师们。

学生们的困境说难听点就是对病理学科的藐视，希望更多的老师和同学们站出来，我们这个群体是有能力的群体，我们渴望得到正视,我们现在的处境就是如草根，但是我们拥有理想和追求，我们会一直努力争取下去，直到看到黎明。。