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A Journey to Pathology 3.0: Our Strategic Debts

Last week three reports competed for my attention.

The Future of Pathology Expert Report curated by Leica Biosystems comprises a compilation of opinions on key issues relevant to #pathology.

A preview of Collateral damage: the impact on cancer outcomes of the COVID-19 pandemic by Amit Sud , Clare Turnbull and colleagues is an alarming estimate of the effects of the pandemic on #cancer patients.

And finally, Commission for Human Future’s Surviving and  Thriving in the 21st Century reminds us of the human species’ talent to self-inflict irreversible damage, general reluctance of authorities to accept scientific evidence, or think long-term. Our history tells us unambiguously of catastrophic droughts, famines, fires, and epidemics. There was a timely warning about the #coronavirus time bomb by scientists, epidemiologists, journalists, and high-profile philanthropists. In spite of all the writings on the wall, we were entirely unprepared for the current pandemic. Ultimately, the #COVID19 pandemic did not break our #healthcare. Our healthcare systems are the reflections of our societies and the legacy of our governments and policy authorities. The pandemic just exposed what is already broken. As John Hewson, the Chairman of the Commission for the Human Future and author of the report, pointed “Coronavirus is a dress rehearsal for what awaits us if governments continue to ignore science”.

The Collateral Damage, presumably the first of many essential studies assessing the sequelae of the pandemic, looks into the impacts of delaying curative cancer surgery. Inevitably, this rapid communication introduces several assumptions that will prompt additional discussions, but its findings will have to be taken seriously by the “policymakers, clinicians and the public”. The report clearly articulates the existing anxiety within the medical community that for a significant proportion of patients, especially those with aggressive types of cancer, delays in diagnosis and surgery, will impact their chances of achieving long-term survival. The #COVID19 marathon (the response to the current pandemic may extend to a couple of years, and we should not exclude other similar events in the future) will require a different approach to using resources and defining individuals’ responsibilities. This goes beyond #cancer; it is universally applicable for other conditions as well as for the complex interplay of all aspects of health and wellbeing. There are no quick answers, but I believe that we should stop running in place. The ideological fervor, current organisational, operational, or clinical siloes, and the zero-sum competition will not help. The effective strategy will need to leverage the integration of care across the organisational boundaries and boundaries of care and leverage the healthcare sector to support societal and economic recovery. 

The opinions in The Future of Pathology revolve around four themes: (i) realising the potential of digital and computational pathology, (ii) advancing cancer care and personalised medicine by power-use of molecular pathology, (iii) improving perception and resource allocation through engagement with administrators, clinical users and other stakeholders and (iv) sustainable talent management by integration, outreach, and life-long learning. It is an interesting read, and it emphasises the number of critical gaps. But to be precise, these gaps are not strategic opportunities; they are strategic debts. The strategic debts are consequences of making poor decisions with regard to the strategy of our profession. For all laudable reasons, similar to our other #laboratorymedicine specialties, pathologists were late with the introduction and scaling of digital and molecular pathology and ineffective with positioning and making pathology the premier career choice. In the UK it is at least in part due to austerity and underfunding. As pointed last week by Severin Schwan, CEO of Roche, the UK has underinvested in healthcare “over many years”, and there are no quick fixes. We will have to scale up digital and molecular pathology, but it would be a shame if we just graft it on the existing service model. The power of computational and molecular pathology could unlock transformation to a more effective, future-proof and equitable service model, integrated diagnostics, distributed and flexible working over larger geographies, and new approaches to talent management and workforce development. This is about taking a pivotal role in optimising and personalising prevention, diagnosis, treatment, and repositioning the specialty in the post #COVID19 healthcare ecosystem from being only a transactional service provider to become a transformational provider of high-quality, laboratory medicine solutions.

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