*Keywords: Dermatopathology, skin specimens, physician burnout, emotional intelligence, detachment, empathy.
*The author has no conflicts of interest to report.
Preparing Dermatopathology Specimens in Proper Context by Travis Dowdle*
As a specimen grosser, I am frequently greeted by samples like this one. Abnormal, soaked in formalin, and disconnected. Without the labeling on the jar there would be no way to ascertain the origin of this tissue. The face and story of this person it was taken from are unknown to me.
“Every piece is a person,” Dr. Michelle Tarbox, associate professor of dermatology at Texas Tech University Health Science Center mentioned before going on to explain other important elements of the position then looping back to the main point: Make sure you keep the proper perspective that these samples are integral for the diagnosis and management of real people. She was referring to my position as a grosser in the dermatopathology lab where I would be preparing skin biopsies and excisions for histological evaluation. As an aspiring dermatologist, I was ecstatic to be given this opportunity.
One year later, I reflect on Dr. Tarbox’s word choice and that she specifically used the word person rather than patient. It’s a subtle yet profound difference, especially for those of us in healthcare. Patient conjures an image of an individual in a gown with no life outside the hospital while person elicits thoughts of someone with hopes, aspirations, feelings, and failures. Each person comes into our world momentarily but will inevitably step back into his own, surrounded by loved ones who care about his wellbeing and dermatology visit.
As I cut through this squamous cell carcinoma excisional specimen, I think about the patient waiting by the phone for his results. He may not have suspected that this itchy bump on his neck was anything more than an irritated bug bite. Perhaps he is a local cotton or peanut farmer who works long hours in the sun. I also frequently think about my mother, who died of colon cancer three years ago, and the family gatherings we had whenever she would receive any lab, surgery, or test result. Channeling these thoughts as I work helps as I connect with patients I don’t know.
Do my own personal attempts to emotionally attach to dermatopathology samples from patients have any broader relevance?
Empathy is the ideal balance between emotional over-involvement and detachment. Physicians are required to be both clinically competent and empathetic toward patients. In practice, it is difficult to find the right balance between being technically skilled and objectively, professionally, and emotionally engaged, yet not over-identifying with a patient’s distress .
When physicians experience burnout, their ability to strike this balance becomes diminished. This can lead to negative, cynical, hostile attitudes and detached feelings toward patients. This is known as depersonalization, where physicians treat patients as objects rather than human beings . Physician burnout is related to factors such as an increasing workload related to EHR documentation, clerical, and administrative duties, coupled with a shrinking number of meaningful interpersonal interactions and high patient volumes . While dermatology in the past had low levels of self-reported burnout, it has been steadily increasing in recent years .
Many in healthcare don’t directly interface with the public, as in my current role as a grosser. Those who do are seeing a shrinking number of daily, meaningful interactions with increasing levels of documentation burden and patient volumes, as is the case of many physicians. This can potentially lead to patient care becoming rote and emotionally draining.
There are no simple solutions for staying connected to those we treat. My suggestion echoes the words of Dr. Tarbox to keep in mind that every specimen is a person. This sentiment applies to more than skin samples and reminds us we must not become complacent, rushed, or lose sight of the importance of what we are doing.
In 2008, two Israeli radiologists performed a study in which they attached patient photographs to CT scans, attempting to evaluate if this could increase connection and empathy towards patients they had not interacted with. They described that this did not lengthen the duration of the examination, however, it did render the interpretation more meticulous and increased radiologists’ levels of empathy. All who participated recommended adopting this practice routinely . This could easily be applied to specimen preparation and visualization in dermatopathology. More research should be undertaken to explore this relationship given that self-reported burnout in dermatology is increasing .
It is difficult to constantly re-evaluate our mindset in an attempt to view every sample, chart, or surgical procedure or study as important, but it is vital to remember someone’s mother, father, or brother is always being treated.
*Author Bio: Travis Dowdle is a 2nd year medical student and aspiring dermatologist and Mohs surgeon at Texas Tech University Health Science Center School of Medicine (TTUHSC) in Lubbock, Texas.
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