Following our recent installments in the June and September issues, we continue our conversation with pathologist Ken Mero, B.S., M.S., DVM, Ph.D., of VetPath Services in Stone Ridge, N.Y., to learn how to choose a histopathology lab and a pathologist.
Why does a different pathologist read my biopsy each time?
This is a feature of the large conglomerate laboratories with a very large professional staff. Cases may be distributed randomly to different pathologists who may be on duty on any particular day.
This can be avoided by using a smaller, generally independent laboratory with a smaller number of pathologists. Whether using a large or small laboratory, cases are usually distributed to a pathologist of choice if requested on the lab’s test request form.
However, it is more likely that your pathologist of choice will be available on a daily basis at a smaller lab. In that situation, you may become more familiar and comfortable with each one of the pathologists, so that if your favorite one is unavailable on a given day you will already be acquainted with the others.
How does one choose a lab?
There are many factors to consider, some logistical, financial, philosophical and perhaps also geographical. Some prefer using a lab in the nearby vicinity. However, this is less of an issue considering current-day communications, such as overnight priority package delivery, fax and the Internet.
In a large lab with more middle men involved with the flow of samples through the system, there is a greater chance of something going awry. With a larger lab, one is more likely to be “lost in the crowd” rather than recognized and respected individually as is more likely with a smaller organization that has a smaller and more select clientele. Depending on their proximity, many large labs have a doorstep pickup courier service as a convenience. Smaller labs may rely on priority overnight parcel service.
Some consider this an inconvenience, but the service you are likely to get from a smaller lab may make this effort of preparing a package well worthwhile. Furthermore, the lab usually provides all the shipping supplies and pays for the shipping, so that shouldn’t be an issue.
Then there are the philosophical aspects of doing business in general. Some like to “go with the flow” with what is currently the trendy lab service in the area. Other free-thinkers realize that smaller labs are non-corporate, non-conglomerate, independent businesses, and they prefer to do business with those that have this aspect in common. Some simply dislike huge organizations.
Then there is the option of choosing a laboratory because of your rapport and/or professional experiences with a particular pathologist.
Another consideration is whether the lab it is full-service: Some offer blood work analysis as well as pathologist services. Depending on circumstance, it may be wise to chose one lab for one service and another laboratory for another. However, a cyto- and histo-lab only is a nice option for clinics that have their own in-house auto-analyzer.
Should cost be a factor?
Lab pricing is competitive but there is some variation. However, hiding behind the price tags are variable service levels and hidden costs. It is important to consider what you get for your money.
One important factor to consider is the price per tissue charge. Some labs charge for every single specimen individually, while others have a different breakdown with a tier system. Some charge extra for special stains. Others discount cytology and histology services for doctors and their employees. Some shine by the brevity of their reports, while others provide a more comprehensive document with more description, discussion, comments and suggestions.
The old adage, “You get what you pay for” applies in this venue also, and often a slightly higher price provides a much more generous product, well worth an extra buck or two. If given the option, many pet owners would probably prefer that their vets get them the most for their money out of lab services, particularly if it results in a comprehensive, informative report of which they sometimes get a copy.
How does one choose a pathologist?
There are many factors to consider in this choice as well. Valid considerations are the pathologist’s professional qualifications (residency training, advanced degrees, board certification), professional background, such as specialized training or experience in a sub-specialty of pathology, years of experience in pathology, and perhaps experience in the trenches in private practice. It can be helpful for a pathologist to have walked in the shoes of a clinician and to have dealt directly with clients, which helps foster a healthy respect for those in private practice.
However, none of these considerations are of major significance if the pathologist cannot or will not relate to or communicate with you. An intellectual professional exchange between clinician and pathologist is most likely to result in the most accurate diagnosis based on clinical input and microscopic appearance. Ultimately, this will lead to better patient management.