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Inside the lab: working in anatomical pathology

Dr Lynelle Govender, a medical doctor and lecturer in anatomical pathology, glimpses behind the laboratory doors

Read this article to:

  • Understand how you can become an anatomical pathologist
  • Discover what typical activities you would carry out in the specialty
  • See what anatomical pathologists say about their chosen career 

What is anatomical pathology?

Anatomical pathology is an exciting specialist field of medicine, which is at the forefront of patient diagnostics.

To enter into anatomical pathology as a registrar, you must complete an accredited undergraduate medical degree, internship and community service. Registrar training programs are four years long, during which time a registrar must complete a Part 1 and Part 2 examination, and a research project.

Anatomical pathology falls within the broad umbrella of pathology – the fields of medicine that are devoted to studying disease and disease processes throughout the human body.

Why study anatomical pathology?

  1. Intellectual stimulation: Anatomical pathology covers the entire breadth of medicine. Unlike other specialist fields that may be limited to a specific organ system, anatomical pathologists are experts of all diseases that affect the patient population.
  2. Diagnostic relevance: Anatomical pathologists are an essential part of a multi-disciplinary team, providing insight into patients’ diagnosis (which sometimes can only be confirmed with microscopy).
  3. Laboratory medicine: Largely based in laboratories, an anatomical pathologist has the benefit of combining a love of medicine with science.
  4. Research: There is an enormous scope of research in anatomical pathology, and enquiring minds will happily find a home here. 

Who do you work for?

All registrars and public specialists in anatomical pathology are employed by the NHLS (National Health Laboratory Service). In the private sector, employment opportunities may be found in private pathology laboratories. 

What is the average day like?

It’s busy – but it’s worth it!

An anatomical pathologist has a long working day, involving extended working hours. Unlike some other specialties, there is little time in the day for breaks “between ward rounds and clinic duties”. New candidates should prepare themselves for the long hours that can be spent in the laboratory. Furthermore, anatomical pathologists work overtime hours by completing extended working hours and rostered on-call duties. The working day is divided between the following typical activities:

  • Histopathology:

    -   “Cut-up”: time devoted to cutting up and preparing macroscopic specimens (for example, specimens removed during surgeries or biopsies for diagnostic purposes).

    -   Microscopy: a large portion of the day is spent reviewing the microscopic slides prepared from macroscopic specimens or biopsies.

  • Cytopathology:

    -   Reviewing cytology specimens such as fine needle aspiration (FNA), body fluids and Pap smears.

  • Reporting: each case, often consisting of multiple slides and other special stains, needs a report to be generated. This is usually done by dictation, after thorough scrutiny of all slides and correlation with other tests and clinical information.
  • Checking: registrars check all their cases with a consultant: all reports must be checked by a consultant before they are authorised.
  • Meetings: anatomical pathologists participate in various multidisciplinary team meetings, where the patients’ pathological diagnosis is discussed with the wider patient care team. 
  • Autopsies: conducting autopsies on natural deaths are also part of an anatomical pathologist’s duties. All registrars are required to complete at least 50 autopsies during their registrar training.
  • Training: various portions of a consultant’s day are devoted to teaching activities, both for registrars and undergraduate health sciences students.
  • Laboratory management: particularly at a senior consultant level, a portion of the working day revolves around the efficient and effective running of the laboratory.

Ultimately, if you find yourself intrigued by the idea of making critical patient diagnoses, while working with specialised laboratory equipment and other brilliant minds, then this is the field for you!

Quotes from the team

“Anatomical pathology, for me, was an ideal specialisation as it allowed me to combine clinical medicine with basic research; a combination that is increasingly in demand." 

It is an intellectually challenging, low-risk, moderately well paid specialist career with minimal patient interaction suited to doctors who enjoy making numerous diagnoses every day with their eyes (and the organ behind the eyes)!” 

Want to know more?

Please contact lynelle.govender@uct.ac.za if you would like to learn more, or visit the Division of Anatomical Pathology at the University of Cape Town.

Dr Govender joined the University of Cape Town’s Division of Anatomical Pathology in an academic and educational capacity.

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