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.

 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．

 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！！！

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？

 从第一页看到第十一页，感慨真的很多。

的确，我们做病理的，搞风险，低收入。

还要时时刻刻担心“秋后算账”。几年甚至十几年后也有可能有人找你说诊断错误打官司的。

精神以及心理压力都非常大，虽然不上夜班，但是白天如果有倾向恶性的片子，夜里有几个是能不想这个睡的很香很甜的呢？

我刚毕业参加工作，目前只能做一些基础的技术工作，还远远没达到能发诊断报告的地步。但是看了这些，真的情况就跟我们科的前辈们跟我说过的 情况一样。

很多地方我都不懂，不发表什么观点，我只希望自己能努力，早日成长为一个合格的病理医生。同时也小小的希望一下国家能提高我们病理人的待遇。我们每天面对甲醛二甲苯的危害，甚至为了减少消耗病理防护服取材服都没有。我们的付出和收入的确不成正比。

不要再让人才流失了。

最重要的是提高病理医生的待遇，实在太低了，连普通的护士都不如，领那么一点米米，实在没得尊严

不能因为困难重重而不去争取，凡事都应该考虑积极的一面，凡事如果认定了，就应该努力的去做。变化才是永恒的。

    老师说的太好了。

    学科的发展，必须配合制度的完善。希望有关部门能重视起来，给有着志愿为病理行业服务的学子一个机会，给病理专业在中国的发展提供更好的条件。

不在沉默中爆发，就在沉默中死亡。

战士当为了理想和追求而浴血奋战！

质疑和讥笑我们可以忍耐，但是上进的心当永不停息！

说的太好了，凭什么让我们这些无辜的学子去承担国家政策上的漏洞！