S01E2: What is anatomical pathology?

Hosted by RCPA Vice President, A/Prof Trishe Leong, Micro Waves is a spin-off podcast series aiming to educate and grow awareness of the pathology career. In the second episode, we explore the work of an Anatomical Pathologist and speak with Dr Natasha Prosser on this critical area of medicine. 

Transcript

00:00:00:01 - 00:00:15:05

[Dr Natasha Prosser]

Anatomical pathology is one of the best kept secrets in medicine. It's a really exciting field. It's intellectually stimulating. So much collaboration with other specialties that we don't see patients face to face. Most of the time we help patients every single day.

00:00:20:08 - 00:00:26:13

[A/Prof Trishe Leong]

Associate Professor Trishe Long. As with all just end, I'm the vice president of the Royal College of Pathologists.

00:00:30:06 - 00:00:35:04

[Voiceover]

Find your path to Pathology with the RCPA Microwaves Podcast.

00:00:41:08 - 00:01:04:09

[A/Prof Trishe Leong]

Hi everyone and welcome to this Super Microwaves podcast. I'm Associate Professor Trish Long. And today I'm delighted to be speaking with Dr Natasha Prosser. Natasha studied and completed her JMO years in Western Australia but when the time came to apply for a pest training position, she decided to make the move to Sydney and where she's now in her final year of training.

00:01:05:03 - 00:01:25:13

[A/Prof Trishe Leong]

Natasha is a member of the RCPA Training Committee and she's passionate about advocating for her fellow trainees and saw the way saw the committee as a way to learn more about the college. And when she's not busy advocating, Natasha has been known to impulse buy art work, particularly during the busy exam periods. Hopefully we'll get a chance to grill you about that as well, Natasha.

00:01:26:02 - 00:01:30:13

[A/Prof Trishe Leong]

Anyway, welcome to the RCPA Microwave Podcast. Thanks very much for being here.

00:01:31:04 - 00:01:33:12

[Dr Natasha Prosser]

Well, thank you so much for inviting me. It's really lovely to be here.

00:01:34:07 - 00:01:58:08

[A/Prof Trishe Leong]

The purpose of these of these little talks really is to get people, give people a little bit of a taste, I guess from someone who's actually working as a trainee and about that to enter the field so they can find out a little bit more about your particular discipline. And in this case, also my particular discipline and what they might be able to expect from training.

00:01:58:11 - 00:02:15:07

[A/Prof Trishe Leong]

So I suppose you're a bit closer to training to training then than I am now and a little bit down the road. But maybe we can start off by giving people, people who don't know a general idea. We start, really start. We always start really basic. So what is what what is pathology?

00:02:15:12 - 00:02:43:11

[Dr Natasha Prosser]

I guess the textbook definition of pathology is the study of disease, but in a medical setting, I guess pathology, it's a medical specialty. And it deals with the analysis of human biological samples. And I guess pathology in general is a bit of an umbrella term with the specialty because it also encompasses a number of subspecialty disciplines which are standalone disciplines, and that includes genetics, haematology, microbiology, as well as anatomical pathology and some others.

00:02:44:11 - 00:03:11:03

[A/Prof Trishe Leong]

So anatomical pathology, I suppose. I suppose if you were working in a hospital where probably the pathologist that people see the most of if you're if you're another doctor. But on the other hand, we're pretty hidden from the general, the general public. I know whenever someone whenever I ask someone to come you know, come and meet me in the Department of Pathology, and I think whenever they walk up to the hospital, they get sent through to they get sent through to where people get blood taken.

00:03:11:14 - 00:03:22:10

[A/Prof Trishe Leong]

So if you had to describe AP, I guess to someone, it doesn't add up to someone who doesn't know anything about it. What is it? What do we what do we do.

00:03:22:10 - 00:03:42:13

[Dr Natasha Prosser]

Well, our specialist specialty does deals with tissue as well as cells. So tissue is pretty much anything that you can cut out. We can cut up. So it can be anything from like a skin biopsy. If you go to a general practitioner and have a sample of have a lesion taken off, or it could be you know, you could be having a surgery for a bowel cancer or breast cancer.

00:03:43:02 - 00:04:01:09

[Dr Natasha Prosser]

So we get all those kinds of tissues. And cytology is also really important for in our field as well. And it's you can see that when you go to again, go to the general practitioner and have a cervical smear test to detect for cervical cancer or if you have a lump that they can take some cells out or some fluid build-up.

00:04:01:09 - 00:04:10:03

[Dr Natasha Prosser]

They can take some fluid out and have a look at the cells under the microscope. So we deal with tissue, which is histopathology and cells, which is site pathology.

00:04:10:06 - 00:04:14:04

[A/Prof Trishe Leong]

So what tipped you over the line to look at AP then?

00:04:14:08 - 00:04:31:07

[Dr Natasha Prosser]

Oh, it's such a tricky question. I think that I really I still don't know what I really want to do when I grow up. 

[A/Prof Trishe Leong]

I mean, I don’t think anyone is. 

[Dr Natasha Prosser]

I know it's so silly, but I think that's still evolving for me. And I know that I probably want to move, you know, with teaching and education as well.

00:04:32:01 - 00:04:56:07

[Dr Natasha Prosser]

But I know that I can incorporate that into my career choice. I think that I, you know, I tried a number of different specialties and every and I wanted to try more. I just felt like I was getting to the point in my career that I needed to make a decision and or, you know, you don't have to, I guess but I needed to make a career decision that was going to secure me a really good job in the future.

00:04:56:11 - 00:05:03:08

[Dr Natasha Prosser]

And it's something that I'm really like doing now and in the future. As well. And I knew that's what it would be for anatomical pathology.

00:05:04:02 - 00:05:31:00

[A/Prof Trishe Leong]

Hmm. Well, like you say, there's certainly there's certainly no shortage of jobs for us. I think job security and that's. Yeah. And look, that is something that people do take into account when they when they're making their career choice, job security. Plus, I I work in working conditions, too. I mean, we absolutely. Yeah, the on call on call is certainly not as onerous as some of the some of the clinical specialties For sure.

00:05:31:10 - 00:06:01:10

[Dr Natasha Prosser]

I've definitely done some horrific calls, shifts like you'd stop at from Friday morning at 8:00 and you wouldn't finish till Monday. You know, 8:00 and you know, 12, 14 hour days and, you know, relentless overnights. I just don't think I enjoyed that any more. So I'm glad I'm doing what I'm doing. I think I just took a bit of a leap of faith and after a lot of soul searching and, and when I applied, I was really happy when I got the position, I knew that was for me.

00:06:01:10 - 00:06:12:00

[Dr Natasha Prosser]

That was a really satisfying thing, that feeling that I knew I was going to do the right thing. But I think it's really difficult when you don't get exposed to that as a junior doctor or medical student.

00:06:12:08 - 00:06:31:05

[A/Prof Trishe Leong]

Yeah, I think that's a real problem at the moment. We have a we have an exposure problem. Everyone sees what doctors do on the wards. Yeah. But it's a lot harder to see what people do in the lab unless you unless you're fortunate enough like you to have done a scientific rotation.

00:06:31:11 - 00:06:32:02

[Dr Natasha Prosser]

Yeah, true.

00:06:32:07 - 00:06:58:09

[A/Prof Trishe Leong]

For me, you know, I probably, I'm a second I'm a second generation anatomical pathologist so I grew up with some I yeah, I was just fortunate. I grew up with someone who did AP. Having said that, yes, growing up as a child still had no idea what they actually did on a day-to-day basis. But that and my father was also quite probably quite a different pathologist from me.

00:06:58:09 - 00:07:21:13

[A/Prof Trishe Leong]

He was, he was an academic, you know, wrote lots of papers. That's my that's my memory of him dictating papers. And in the evening but that I guess at least I had I knew that it was available as a career as a career option. Hmm. And I think a lot of med students maybe don’t even think of it now as a possibility.

00:07:22:04 - 00:07:49:04

[A/Prof Trishe Leong]

You're still fairly early in your career. But I've found as far as my career has progressed, I've liked the fact that in AP you could either choose to this sort of different nations for different people. You can be quite a generalist maybe, and work in work in the private sector. You can choose to be someone who sub specializes in a certain you know, in a certain organ system and, you know, become a bit of an expert there.

00:07:50:01 - 00:08:13:12

[A/Prof Trishe Leong]

Or you can even you can even sort of, I, I feel like there are options for you like over the course, over the course of my career, I've done perinatal pathology, I've done cervical, I've done cervical cytology and now I do molecular. So lots of different, different areas that you can get involved in that.

00:08:14:00 - 00:08:39:12

[Dr Natasha Prosser]

Yes, you can interact. It certainly carve a direction for yourself. I actually like the idea of being a little bit more general. I think that the, you know, one of the benefits, especially as a registrar, we get to see so many different things every single day. You know, it can be anything from a little skin biopsy to I think when I first came to anatomical pathology, they were talking about pelvic exam operations, which I've never heard of, you know, in my career.

00:08:39:12 - 00:08:58:14

[Dr Natasha Prosser]

And when I saw them, it was quite an incredible specimen. It was, you know, a cat would basically an exaggeration is a removal of like a locally aggressive or locally advanced malignancy in the pelvis. And it can include pretty much anything that's left in them in the pelvis and including some of the bone and, you know, side criminal and other areas as well.

00:08:59:01 - 00:09:10:09

[Dr Natasha Prosser]

And these are quite remarkable specimens that that we get to deal with on a daily basis. So it's not just one system. You know, you've got gynaecological, you've got out breast and brain as well, you know, really diverse specimens.

00:09:11:10 - 00:09:19:00

[A/Prof Trishe Leong]

So what sort of traits do you think you are good to have if you're if you're thinking about becoming an cryptologist?

00:09:19:12 - 00:09:41:01

[Dr Natasha Prosser]

I think that probably having a really good eye that's really helpful. Like you, if you're a good problem solver and your you've got good sort of intuitive skills. But I think having a good eye for pattern recognition and subtlety using in the things that you're saying really makes a difference. You you've got to have I think you've got to be a bit of a lateral thinker as well.

00:09:41:02 - 00:10:00:06

[Dr Natasha Prosser]

I don't think that's a compulsory thing, you know, but it certainly helps to think that, you know, why things happen. So just an innate curiosity. And I think that some other things would be probably helpful for everything in medicine. But I think one of the most complimentary things anyone has ever said to me is that you're a sensible person.

00:10:00:06 - 00:10:03:00

[Dr Natasha Prosser]

And it sounds like I said like a backhanded compliment.

00:10:03:00 - 00:10:05:10

[A/Prof Trishe Leong]

No, no, no. I try, process thinking. Yeah.

00:10:06:09 - 00:10:29:00

[Dr Natasha Prosser]

And it's been careful. It's been safe and knowing your limitations and knowing where to go to go for help and being aware of that is the most important job in the world is to look after that patient and being able to be very careful and thoughtful about that process. And I think the other thing that is really important as a pathologist is being able to interact with other people.

00:10:29:00 - 00:10:33:02

[Dr Natasha Prosser]

So definitely your interpersonal skills really comes into place with with that.

00:10:33:14 - 00:10:44:09

[A/Prof Trishe Leong]

You know, do you have a particularly memorable patient experience or an interesting case that that you might be able to describe for our listeners?

00:10:45:10 - 00:10:53:07

[Dr Natasha Prosser]

Oh, yeah, I, I think that we often get very strange specimens through anatomical pathology.

00:10:53:14 - 00:10:55:05

[A/Prof Trishe Leong]

We get things in big buckets.

00:10:55:13 - 00:11:31:03

[Dr Natasha Prosser]

Yeah. A big bucket of mucin. That's pretty disgusting. We got a knife one day someone, someone had been stabbed and they went to the emergency department with a knife sticking out of them and they didn't know what to do with this knife, so they sent it to anatomical pathology. It's not, it's a very impressive if someone did a, an endoscopic examination of the patient and they looked into their stomach or they had small intestine and they, they tried to take a little biopsy and they ended up taking out what they thought was a mucosal biopsy, and it turned out to be a tomato seed.

00:11:31:06 - 00:12:01:11

[Dr Natasha Prosser]

But anyway, we processed that and it looked so cute underneath the microscope, it actually had hair on it. And so you could you could picture match it histologically and tell what type of tomato was that was really cute. And I guess so that's specimens like surprise me every day are those extensive pelvic exam interactions. And I think I've had we deal quite frequently in like soft tissue and bone tumours and we can have things like hind quarter amputations or four quarter amputations.

00:12:01:11 - 00:12:17:10

[Dr Natasha Prosser]

So it's pretty much an entire leg or an entire arm that comes in. And that's quite a significant procedure. And often they're young people as well. So, you know, been able to address those and care for that patient in that way. That's, you know, quite I feel quite encouraged by that in my field.

00:12:18:10 - 00:12:22:06

[A/Prof Trishe Leong]

Every so everything from the ridiculous to the fascinating.

00:12:22:12 - 00:12:25:05

[Dr Natasha Prosser]

Yeah, exactly. I think the range of things.

00:12:25:12 - 00:12:48:09

[A/Prof Trishe Leong]

I got the ridiculous call last night from specimen reception. I'm on call at the moment and they rang to ask me, what should we do with the specimen? So can you read out the clinical notes to me? I said, foreign body from left nostril yeah. OK, put that in the fridge. We'll deal with that in the morning foundation.

00:12:49:01 - 00:13:03:04

[A/Prof Trishe Leong]

Yep. Oh, so you're at the end of this. Is your fifth year Natasha? In training? Yeah. So can you maybe just quickly outline the training pathway for, for people if you're, if you want to become an Anatomical Pathologist.

00:13:03:13 - 00:13:23:09

[Dr Natasha Prosser]

Sure. So to become an and technical pathologist, it's a, it's a medical you have to have a medical degree. You have to have two years in the field, basically. So at the moment it's, it's an intern year and a resident or a registrar, you depending on what you're doing, but a minimum of two years working in the general system and you can apply for training after that, after that.

00:13:23:09 - 00:13:43:14

[Dr Natasha Prosser]

And if you secure a position, it's a five-year training program with that, there are a number of examinations that you have to do. So there are there's the basic pathology examination, which we'll probably talk about later as well as a number of other sort of exams to see you through the third, fourth and fifth year to check your competencies.

00:13:44:07 - 00:14:16:07

[Dr Natasha Prosser]

There is also a portfolio that you have to submit, which is it's basically a combination of elements that you have to have done incorporating research as well as teaching. So it's not too onerous. It is quite interesting to try to put that together after you have finished your time in the field as well as your examination and your portfolio components and you pursue you're done, done that time in the field and you are eligible to become a fellow of the college and seek employment as a consultant to a star specialist.

00:14:16:12 - 00:14:23:10

[A/Prof Trishe Leong]

We cannot forget the most critical question of the interview. Natasha tell me about your impulse buy artwork.

00:14:25:12 - 00:14:51:00

[Dr Natasha Prosser]

It's fairly guilty, a guilty pleasure when I should be studying. And I, you know, I go into different websites, and I see these new artists and I'm quite excited by this. I buy things to cheer me up and get me through the exam lull. I think since moving to Sydney, I've seen a lot of local out of this which I really, really love, really enjoy the work of the local artists and especially when they represent things in my environment that I identify with.

00:14:51:00 - 00:15:19:06

[Dr Natasha Prosser]

Like, you know, they're the Banksia Tree or a river or something like that. So and sort of a little bit, you know, unusual things like that. Most recently there's a group of people that if I can say this, I can it's kind of like a charity. It's called The Ink Cognito Art Show. And it's a collective that people donate their art and artists from like famous artists and, you know, not famous artists, medical students and all sorts of things do a painting and they submit it to this art show.

00:15:19:09 - 00:15:43:03

[Dr Natasha Prosser]

And then it goes on sale and you can purchase the art for $100 and all that money goes to that art foundation, the Incognito Foundation, to support disabled artists. And you can purchase it for $100. But the catch is you don't know who it's by so you could buy, you could purchase something that's where thousands of dollars, or you could, you know, purchase something that, you know, some kids don't know that all amazing.

00:15:43:03 - 00:15:46:05

[Dr Natasha Prosser]

And you know, that's the whole point of it. It's just such a great initiative.

00:15:46:06 - 00:16:05:02

[A/Prof Trishe Leong]

Well, you make anatomical pathologists sound far more sophisticated and cultured. Well, look, thank you very much, Natasha. It's been I hope it's been illuminating for the people who are listening. I think I think it's been a great talk. But do you have any final words for medical student who is considering anatomical pathology?

00:16:05:07 - 00:16:32:13

[Dr Natasha Prosser]

Absolutely. Thank you so much, Trishe. I think that anatomical pathology is one of the best kept secrets in medicine. It is for me and many others. It's a really exciting field. It's intellectually stimulating. It's an interesting field. There's so much collaboration with other specialties. And we at the end of the day, even though we don't see patients face to face, most of the time we help patients every single day.

00:16:33:06 - 00:16:38:07

[Dr Natasha Prosser]

And I think that really is one of the most satisfying things of my job and career.

00:16:38:12 - 00:16:42:05

[A/Prof Trishe Leong]

It's fantastic. Thanks again, Natasha. It's been great.

00:16:44:00 - 00:16:49:12

[Voiceover]

To find out more about a career in pathology. Go to our RCPA.edu.au.