Professional Documents
Culture Documents
APC/PRODs
Colorado Springs, CO
July 2007
1
The struggle of today, is not altogether
for today—it is for a vast future also.
Abraham Lincoln, (1809-1865)
2
Technology is transforming the delivery
of patient care
Chaotic
healthcare philosophy
on
iati n
ar
V w ee
bet tyles
Flux
Medicine
and medical research
S
is occurring affecting
ic Reactive
E
a
p
t
i sod of
nt
me ms
Care treatment and early
Tre Syste
detection of disease
Time
• Minimally invasive/incision-less
surgery What happens when
• Tissue characterization and imaging there is no tissue to
(virtual histology; microendoscopy)
• Molecular medicine; Tumor-specific in look at?
vivo biomarkers
• Proteomics
• Virtual colonoscopy
• Integrated information systems
• HPV and other vaccines
5
Adapted from Clinical Chemistry 53 No. 7: A Case for Integrated Morphomolecular Diagnostic Pathologists, Manuel Salto-Tellez
Phenotypic-Molecular
Clinical Dimension of
Pathology
Prognosis and Treatment
Loss of
Heterozygosity Specific
Translocations 20210 A ERPR Status
Analysis
Detection of HPV Microsatellite B & T cell Analysis of
Factor V-Leiden
Infection Instability rearrange- HER2-neu Stats c-kit Mutations
Analysis ments
Type Sources
• Standalone •Molecular identification - new information
• Aggregate Panels •IT/Data Mining - new and historical information
•New identification from non-molecular sources
6
Adapted from Clinical Chemistry 53 No. 7: A Case for Integrated Morphomolecular Diagnostic Pathologists, Manuel Salto-Tellez
Phenotypic-Molecular
Clinical Dimension of
Pathology
Prognosis and Treatment
Pharmacogenomics
Loss of Specific
Heterozygosity Translocations 20210 V ERPR Status
Analysis
Detection of HPV Analysis of
Infection Microsatellite B & T cell Factor V-Leiden HER2-neu Stats c-kit Mutations
Instability rearrange-
Analysis ments
7
Adapted from Clinical Chemistry 53 No. 7: A Case for Integrated Morphomolecular Diagnostic Pathologists, Manuel Salto-Tellez
This isn’t Star Wars
Table of Valid Genomic Biomarkers in the Context of Approved Drug Labels
Biomarker Primary Drug Biomarker Primary Drug
Drowning or
drug overdose?
Pathology is no exception
The Battle of the Barbers and Surgeons, 18th c. caricature
The treatment team does not know how to interpret the volume of
diagnostic data produced—pathologists are the best qualified to
bridge this gap and infuse the health care system with real value
18 2020 Vision
Pathologist Monitoring & Direction
Portion of patient
Prognosis
AP • • • CP RadRx Rx RadRx
Molecular PGx+Rx
Predisposition/
Signs/Symptoms
Diagnosis Prognosis Resolution
Entire Patient
• Technology
• Data
• Organization
• Processes
20 2020 Vision
Pathologists will expand their sphere of
influence using all tools and knowledge
available
• Keep current with literature/research
– Be passionate about life long learning
– Investigate emerging technologies that may improve and/or disrupt
practice
• No longer define practice as either AP or CP; expand beyond the
tissue on the slide—integrate the knowledge available
• No longer be satisfied with providing just the diagnose; expand the
value provided by influencing prognosis and treatment
• Collaborate with others providing diagnostic data and take central
role in directing the treatment team
– Integrate information into an easily understood, comprehensive patient
report; become the chief medical knowledge officer
– Seek expertise when necessary; utilize a central repository for
necessary criteria for Dx, Px and Rx guidance
21 2020 Vision
“It is not the strongest of the
species that survives, nor the
most intelligent, but the one
most responsive to change.”
Charles Darwin
English Biologist (1809-1882)
22 2020 Vision
…so, what can you do?
• Acknowledge the market forces
that are driving changes in the
practice of pathology
• Understand the implications and
embrace opportunities these
changes offer
– Engage the change by integrating
new concepts and technologies
into your programs
– Expose your residents to both the
organizational and technology
skills needed
– Don’t use the ABP certification
exam as the only guidepost—
prepare your residents for the new “I’ll be happy to give you innovative
landscape thinking. What are the guidelines?”
23 2020 Vision
24