In the hospital, there is such a mysterious and special group of people...

　　They deal with infectious agents every day and are always exposed to the danger of formalin eroding their health.

　　They are not chefs, but their workbenches are like stovetops, complete with pots and pans, refrigerators, and ovens;

　　They are not judges, but they decide cases every day, and there can be no "unjust, false, or wrong cases";

　　They hardly have direct contact with patients, but they can see through the microscope the life and death struggles and emotions that patients and their families are experiencing.

　　They do not have the ability to master life and death, but every result presented from their hands may be a watershed in the life of the patient.

　　　　They are called "doctors among doctors" and "judges of life".

　　They are a group of "behind-the-scenes heroes" hiding behind the doctors-pathologists!

　　-01

　　More than 40 process pathological sections

　　To many people, this group appears mysterious and unfamiliar. Their working environment is incompatible with the crowded, hustle and bustle of the hospital. This place is like a "pure land", with no patients coming in and out, no family members happy or sad, and no mechanical call prompts, only cold medical equipment, trivial information checks and bursts of formalin stings. Nose smell...

　　Every day, all kinds of human tissues that have been surgically removed are sent here. The lumps on the patient's body and the tissues taken out by various biopsy punctures are packed in transparent specimen bags filled with formalin. The work of pathologists is precisely these shuddering human tissue samples. The first thing after receiving the specimen is to take the material, select the diseased tissue from the submitted specimens to make pathological slices, and go through the process of fixation and dehydration overnight, and then embed the diseased tissue in paraffin the next morning. The pathologist needs Cut the tissue into glass sections with a thickness of 4-6 microns. This process requires more than 10 steps and nearly 40 procedures, almost all of which are manually operated by pathologists.

　　After these tedious and tedious procedures are completed, pathologists can use microscopes and various modern equipment to observe whether the tissue has lesions, which lesions are present, inflammation or tumor? Is it benign tumor or malignant?

　　--02

　　30-minute fate diagnosis

　　The 24-year-old patient was found to have lumps on both breasts for 4 months. At this moment, the doctors are making the final judgment for her. If it is benign, then everyone is happy; if it is malignant, it means that the girl who is in the blooming season may lose her breasts.

　　As before, the surgeon put the excised mass into the specimen bag. The staff who had been waiting outside quickly put the specimen bag into the specimen box and trot towards the pathology department. The pathology department is located on the southernmost side of the fifth floor of the outpatient building. Compared with the crowded four floors below, the fifth floor is very quiet. Many patients do not know that their destiny will be determined here.

　　The pathologist on duty took the specimen sent, quickly registered the number, and then skillfully put on the gloves and mask to collect the specimen. After sampling, continue to put this piece of tissue in a cryostat at minus 25 degrees Celsius for freezing. After ten minutes, technicians cut the frozen specimen into sections with a thickness of 8 microns for staining.

　　The final "ruling result" is breast fibroadenoma, which is a benign disease. Everyone is happy.

　　The family members of the patient waiting outside thanked the surgeon repeatedly. They didn't know that the girl's breasts were preserved because of the diagnosis made by a pathologist who had never met.

　　--03

　　can only be alone after 10 years of graduation

　　There are three "threshold fees" circulating in the pathology community: for more than 10,000 cases, a preliminary pathology report can be issued; 30,000 cases can be handled before the report of a lower-level doctor can be reviewed; and difficult diagnoses can be resolved with more than 50,000 cases. Calculating by looking at 20 slices a day, 50,000 cases will be completed, and it will take ten years to watch without distraction. The most important part of the pathology department is watching the film.

　　It is easy to say, but this link tests the pathologist’s ability to "grind a sword in ten years". A qualified pathologist generally needs 5 years of residency training, and completes the required training items to be qualified as a practicing pathologist; from graduation to acting alone, it takes at least 10 years. In large hospitals with strict requirements, only doctors with the rank of deputy chief physician or above are qualified to sign the report. This amount will take at least 15 years, which is much longer than the mature time of doctors in other clinical departments...

　　--04

　　represents the diagnostic level of the hospital

　　Pathological diagnosis is very important for clinicians to decide the surgical plan during surgery. For example, to determine the nature of the lesion, whether it is an inflammatory lesion or a tumor, benign or malignant, to decide whether to undergo radical surgery or local resection; or to understand the infiltration and spread of malignant tumors, such as whether the edges are involved and whether there are lesions in surrounding tissues, Whether there is metastasis around the tumor and the distant lymph nodes determines the scope of surgery.

　　Nowadays, no matter how sophisticated the inspection equipment and the methods are, the role of pathologists is irreplaceable. Even the level of pathology in a hospital represents the overall level of diagnosis and treatment in a hospital.

　　--05

　　Every pathologist may stand on the bench

　　Although pathological diagnosis is the gold standard, the disease is ever-changing in patients of different ages, genders, and even different parts of the same patient. Some complicated cases may not be able to get a clear diagnosis at that time. Therefore, pathologists are "stunned step by step" from collecting materials to diagnosis. Doctors' pathology reports are more and more cautious. They are often described as "highly suspected", "may be A or B", and "do not rule out C".

　　General pathologists have to go through the "three realms": they are very courageous when they first distribute films independently, they will become courageous after they have made several mistakes and corrected by a superior doctor, and when they have read countless pictures and have enough experience, they will change again Great, this ups and downs process will take at least ten years, and many who can’t survive will change careers in the middle.

　　--06

　　"Golden" sells cabbage price

　　We know that the production of a small slice requires multiple processes, and each step has strict requirements on time, temperature or reagent concentration, and most of them are done manually by pathologists. However, pathology fees only include technical fees, and doctors’ diagnosis fees are almost zero. This is unacceptable to many doctors.

　　For example, a histopathological diagnosis requires 3 to 5 working days for pathologists and technicians to complete, but the fees for this project basically range from tens to 100 yuan across the country. Except for the reagents and consumables required for diagnosis, depreciation of equipment and equipment, there is no room for labor costs at all. Such pricing makes the labor value and knowledge value of pathologists not reflected.

　　The unreasonable "cabbage price" has made the pathology department a recognized Qingshui yamen in the hospital. The annual income of the department only accounts for less than 1% of the hospital's total income. Usually, the income of pathologists is only half or even three of that of surgeons. One part. Pathologists do not make money, which directly affects the employment choices of medical students.

　　--07

　　The status quo of the pathology circle in the country: "No one does it, no one knows, no students learn"

　　According to statistics, there are only more than 9,000 licensed pathologists across the country. According to the calculation of 1 to 2 pathologists for every 100 beds, the gap is as high as 40,000 to 90,000. In recent years, qualified and experienced pathologists have gradually entered an advanced age and left the frontline. At the same time, due to the heavy workload, low income, long training period, difficulty in obtaining scientific research funds, fewer opportunities to publish high-quality academic papers, and low sense of achievement to stand out, clinical medicine graduates choose to engage in pathology teaching and diagnosis. The lack of enthusiasm for pathology has led to a "cliff-cliff" shortage of pathology teachers and new pathologists. This "father of modern medicine" William Osler called the pathology department "the foundation of medicine", but faced such a bleak situation in China...

　　Pathology is the foundation of medicine, and the difficulty of pathology is the pain of medicine. Establish a reasonable fee mechanism, raise the fee standard for pathological diagnosis, and respect the labor value of pathologists. Returning pathology to its standard is the future that every doctor wants to see.

　　Note: For reference only, not a factual basis, please refer to official official statistics and actual conditions.