Deputy Professor Fan Xiangshan, director of Pathology Department of Nanjing Gulou Hospital
"Are you willing to go to the pathology department after graduation?"
Fan Xiangshan, associate professor of pathology of Nanjing Gulou Hospital (Gulou Hospital Affiliated to Nanjing University Medical College), always asks this question when the new semester starts. However, he only gets the same answer every time - there is no sound in the classroom and no one raises his hand to answer the question.
"We found through observation that in the past 10 years, the graduates of Nanjing University Medical College basically didn't choose to go to pathology department, let alone take the examination of Postgraduates of this major." In an interview with the doctor, fan Xiangshan was heavy and worried.
Pathology department was once called "the foundation of medicine" by William Osler, the father of modern medicine, but in China, it is always in the awkward position of "being good but not being popular". Lack of talents, high work intensity, high risk, low income and other factors have become the bottleneck restricting the development of the discipline. How to break the situation and development is like a huge stone pressing on the heart of every head of pathology discipline. "This is a battle to break the situation. The purpose is to make the pathology department return to the standard and play its due role." Fan Xiangshan said.
No one's going to learn, no one's going to do it
Pathologists are often called "doctors of doctors" and "detectives" among doctors. However, opening the Department overview of the official website of each major hospital, pathology department, laboratory, imaging department, etc. can only stay in the classification of medical technology departments, and even many hospital pathology departments are divided in the large laboratory, with only one or two rooms, next to the toilet and corridor corner.
"In developed countries in Europe and the United States, the pathology department not only understands the anatomy pathology, but also includes the clinical pathology, the latter is equivalent to our domestic laboratory. However, pathology in China is limited to pathology in a narrow sense, and there are obvious differences in system and size. " In recent years, fan Xiangshan visited MD Anderson Cancer Center, Massachusetts General Hospital Affiliated to Harvard Medical School and Brigham women's Hospital and other well-known hospitals in the United States, and deeply felt the development gap between domestic pathology department and foreign ones.
"Compared with pathological diagnosis, lack of talents is the biggest crisis in the development of pathology." Fan Xiangshan told reporters that there are only about 15000 pathologists in China, and the number of technicians is less than 30000. According to the allocation requirements of 1-2 pathologists for every 100 beds of the national health and Health Commission, the gap of pathologists is as high as 60000-90000. In contrast, more and more medical students are reluctant to choose pathology department because of many factors such as high pressure, high labor intensity and high occupational risk. "No one to learn, no one to know, no one to do" has become a hindrance to the development of the Department.
"The third tier hospitals are still like this, and the grass-roots hospitals are even more difficult. Even many hospitals have failed to recruit new doctors for many years." Fan Xiangshan was worried about the development of the Department. "We can still insist on lacking people in the next few years, but if we continue to lack people in the next 10 or 20 years, it will be a major blow to the discipline and even the whole medical industry." He said that the shortage of human resources leads to the overload of the working staff, but the pathologist is a person or a machine. Under the high-intensity work pressure, the service quality and efficiency can not be guaranteed at all, thus forming a vicious circle.
Fan Xiangshan sighed: "it's a true portrayal of a pathologist who is like walking on thin ice."
Promote the development of "sub specialization" of Pathology
Is the pathology department, which is called "the foundation of medicine" by William Osler, the father of modern medicine, really going to be an auxiliary department in China? "In such a big context, this problem is largely beyond our personal ability to solve, but we can decide what we should do ourselves." According to fan Xiangshan, the key issue is not how to locate the pathology department, but what the pathology department can do to play an important supporting role in the clinical and scientific research work of the hospital. "Only when it really works can hospitals rely on you, countries rely on you, and disciplines get attention and development."
Fan Xiangshan thinks so and does so. Since taking over as the director of pathology department in 2015, he has taken the initiative to improve the department management, optimize the workflow, improve the quality of pathological report and shorten the period of pathological report based on the clinical needs. At the same time, the Department members are encouraged to "move from behind the scenes to the front of the stage", participate in MDT consultation or outpatient activities as the backbone force, deeply involve in the diagnosis and treatment of diseases, and play the platform supporting role of pathology department.
Pathology department participates in multi-disciplinary expert clinic for difficult cases of digestive system
"Nowadays, the country advocates the development of precision medicine, the premise of which is precision diagnosis, so how to achieve precision diagnosis? In fact, pathology is an indispensable part of it. " The pathology department led by fan Xiangshan has a young and vigorous pathology diagnosis team, which is highly innovative and challenging, and actively explores new ways for the development of sub specialties.
Taking tumor as an example, early diagnosis and early treatment are advocated in China, but to some extent, clinicians pay more attention to the quantity of treatment and ignore the quality, or "pay more attention to treatment than diagnosis". In order to actively respond to the national policy and improve the level of early diagnosis and treatment, the pathology department and the digestive department cooperated in depth. According to the advanced experience of Japan and the national conditions of China, the joint diagnosis and treatment project of early gastrointestinal cancer was carried out. Through the establishment and continuous improvement of the new endoscopic pathological diagnosis and treatment mode of early gastrointestinal cancer, the diagnosis rate of early gastrointestinal cancer in Gulou Hospital was increased to nearly 40% at present. "Although this figure is still lower than that of Japan and South Korea, it has made great progress compared with less than 10% five years ago, which is also a very leading figure in China."
The team of Gulou Hospital went to Shuntian hospital in Tokyo, Japan to exchange the multidisciplinary work mode of endoscopy pathology diagnosis of early gastrointestinal cancer. The picture is with Professor Takashi Bashi of pathology department
"Through deep cooperation with the clinic, we have a comprehensive understanding of the disease. At the same time, with the help of our sub specialty platform, we can support each other and advance together with the clinic. " Fan Xiangshan said that the change of working mode has played a positive role in promoting the overall diagnosis and treatment level and medical quality of the disease, and accelerating the transformation of clinical research, which is a win-win cooperation among all parties.
It is worth mentioning that the project team of early gastrointestinal cancer of Nanjing Gulou Hospital not only focuses on the improvement of its own ability, but also plays a leading role in many domestic hospitals. In the past three years, the pathology department of Gulou Hospital has trained 89 pathologists for the diagnosis of early gastrointestinal cancer for dozens of large hospitals in the Midwest of China according to their own expertise, so that they can go back to their own hospitals and improve the diagnosis rate of early gastrointestinal cancer.
The "outstanding achievements" of the deep cooperation between the pathology department and the digestive department of Gulou Hospital have attracted the attention of the state. In January 2019, the international exchange and cooperation center of the National Health Commission organized leaders of more than 30 large hospitals and comrades from digestive department, pathology department and medical department to gather in the drum tower to listen to advanced work experience and discuss the diagnosis and treatment of early gastrointestinal cancer in China.
Digital pathology is the future development trend
General secretary Xi Jinping once said: "the most powerful weapon for human beings to compete with diseases is science and technology. Human beings cannot do without scientific development and technological innovation." As the "gold standard" of disease diagnosis, pathological examination is closely related to science and technology.
"In recent years, with the development of science and technology, pathology has also embarked on the fast track of discipline development." Fan Xiangshan said that the pathology department is always in line with the pulse of the times, supported by modern hardware facilities, With the soft power of scientific management methods as the starting point, the pathology work has been transformed from the traditional manual workshop mode to the automatic, standardized, standardized and modern inspection mode. The gap between the technical levels of different hospitals has also been gradually narrowed due to the standardization and standardization of the pathology work.
"The development of molecular pathology, concomitant diagnosis, liquid biopsy, high-throughput gene sequencing and other emerging technologies provides genetic evidence for the clinical treatment and prognosis prediction of patients, and provides full protection for the clinical treatment." Fan Xiangshan mentioned that the development of intelligent pathology and pathohistology, especially digital pathology, artificial intelligence and remote pathology, has put a flying wing in pathological diagnosis and research.
With the rapid growth of cancer incidence rate and the high technical requirements and long training period for pathological doctors, the current pathological diagnosis in China is facing the problems of uneven distribution of medical resources, serious shortage of doctors and uneven levels. In digital pathology, digitizing the slices is the most basic and critical step. Doctors only need to transform pathological section scanning into digital section and upload it to the network diagnosis platform. Pathologists in other places, even on the other side of the ocean, can make pathological diagnosis directly online and send out diagnosis / consultation opinions, so as to realize rapid diagnosis. "The emergence of digital pathology has effectively saved the human and time cost of the pathology department of the hospital, avoided the patients from tossing and waiting in the major hospitals, and also improved the diagnosis level and operation standard of the underdeveloped medical areas in China, which is the inevitable trend of the development of the pathology department."
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In the interview, we can clearly feel the doctor fan Xiangshan 's eagerness and expectation to improve the development of pathology.
He said he hoped to get policy support at the national level to help the rapid development of disease science;
He said he hoped that more excellent doctors and medical students would join the team of pathology to improve the development of pathology;
He said he hoped that the pathology department would return to its standard and play its due role.
He called for attaching importance to the policy making of pathology talents training;
He called for further cooperation in clinical pathology;
He called for the establishment of the concept and system of major pathology in China.
Dr. Fan Xiangshan expressed the responsibility and responsibility of this generation of young and middle-aged managers of pathology department. In recent years, with the joint efforts and appeals of many predecessors and peers in the field of Pathology, the development status of pathology is gradually improving. The state has issued a series of policies and documents conducive to the development of Pathology, including in the performance evaluation of public hospitals, pathology is also one of the criteria for independent evaluation.
Pathologists are relying on their own professional knowledge and practical actions to make pathology play the role and power of "medical foundation". Many disciplines suffer, and our generation should be self-improvement. We believe that with the efforts of many ambitious young people who dare to work hard and fight bravely, pathology will usher in the spring of development!
Editor: Wang Lei reviewed by: Xiong Wenshuang
Contribution email of doctor: yishibao2017@163.com
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