Emerald Coast Medical Mastery
Get to know the physician members of the Emerald Coast Medical Association. Empowering Physicians to Promote the Highest Quality Patient Care.
Emerald Coast Medical Mastery
Episode 19: Dr. Scott Taylor, DO
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You will never meet him. But if you have ever had a biopsy, his eyes or his colleagues' eyes were on it. Scott Taylor, DO, is the pathologist who puts a name to cancer every single day. A supervisor once wrote that he was a waste of a personality on pathology. This conversation proves how wrong that was.
Well, hello and welcome again to the Medical Mastery Podcast, the podcast of the Emerald Coast Medical Association. I'm your Amoranthine host, Don Davis MD, and I am excited to have a guest, a pathologist, Scott Taylor, MD with KWB Pathology. Thank you for being here today on Medical Mastery. I appreciate the invite. I'm very excited to be here. Okay, well, uh, we're gonna test that grounds here in just a little bit, okay? Um so according to my notes here, it says you're a pathologist. I have no idea what that is. A lot of people don't know what it is. Well, okay. My family probably doesn't even know what that is for the most part. I'm not entirely certain my family knows what I do. So um I I've had this dream for some time that I want um my wife to find out that I had never actually graduated medical school. I'm just going every day to the mall for hours. Yeah, figuring it out. Okay. So um Chris, she you edit that out, please. Um now let's start off. Um we're gonna get to your story, we're gonna get to what you do day to day, um, and probably answer some burning questions that a lot of our audience will have about um what it is that pathologists do, and hopefully you can uh help us solve medicine while we're here.
SPEAKER_01Okay.
SPEAKER_02Um but let's start off by uh talking about you. Where are you from?
SPEAKER_00I'm from right here in Panama City. Oh never heard of it. Okay, good, good. I grew up uh over in Callaway. Okay. Uh behind Brooks, Bait and Tackle in the little Brock Holmes. All right. Uh until about I was age eight or nine, and then we moved out to the Deer Point Lake area. Uh went to high school at uh Mosley. Mosley, okay. Mostly Dolphin, yeah. My wife was too, yes. Graduated in 05. Um met my wife uh in high school. First time I saw her was at Harters Park. We were on opposite soccer teams. First time I ever laid eyes on her. Um and uh our first date was a walk down Panama City Beach, you know. Nice. Um so a lot of history here. Um true local, huh? Okay. Absolutely 100%. Um my first real job uh was at one of the local hospitals here. I was valet parking cars. Oh filing x-rays. Piling x-rays the old school, yes. Oh yes.
SPEAKER_02Yes, my wife's practice used to have uh the rolling light boxes there. That was uh again, uh uh Halcyon days. Very archaic how far we have come from. Indeed, in some ways. Um so so you born and raised here now.
SPEAKER_00Tell me uh what your family does. Uh so my mom's an RN, 35 years, she just retired. Oh, good on her about six, eight months ago. Shout out. Uh very excited about that. Yeah. Uh my dad uh cut grass for a living. Okay. Uh did that, owned his own business, did that for a good number of years. All right, great. Um, and uh so yeah, I think that initial interest in medicine for me probably came from my mother, you know, um watching her every day go and take care of patients. Um she worked on the cardiac floor here in town. Okay, I'm sorry.
SPEAKER_02Um and so uh she kind of extilled a little bit of that uh Yeah, and then also uh apparently, you know, some hard work uh values uh that your dad is um instilling in you.
SPEAKER_00Absolutely, absolutely, yeah. Uh taught me how to uh work hard. Um one of the things he always said is you might not be the smartest guy in the room, but you can outwork everybody else. That's something that you can do, that's something that you can control. And so um that kind of that kind of stuck with me.
SPEAKER_02You know, the the unwillingness to stay down if you're knocked down, that is what truly is gonna create success. Because, you know, as you've gone through this training that that we've recapitulated a fair amount of that, um you end up you get knocked down several times.
SPEAKER_00Oh, gonna get back up. I'm not gonna stay down. Absolutely. Um that's one thing I've kind of learned throughout my career is there's gonna be a lot of hardships, trials. People are gonna tell you no, you can't do something. Of course. And I think that's what gets you through it is you just never take no as an answer. Yeah, too stubborn to take that.
SPEAKER_02Yeah, as soon as you tell me no, I'm like, hmm, all right, no, I don't know. Um now tell me about uh where did you do undergrad?
SPEAKER_00Um so I got my associates here at Gulf Coast. Okay. Super local guy. Okay, great. Yeah, saving money, staying at home, doing all those smart stuff, right? Right. Um and that's also about the time I met my wife, so I'm glad I've made that decision. It's a smart move. Yep, absolutely. Um and then um I did my undergrad over at um FSU, got my bachelor's degree there. Okay. Yeah. What'd you study at the time? Uh biological science.
SPEAKER_02Okay. Now, so were you leaning towards medicine at that point, or did biological science hold some sort of thrill for you?
SPEAKER_00No, I I I was kind of leaning towards medicine, you know, at that point. Um there were another, you know, other things kind of in that field that just kind of interested me. Um at one point in time I did kind of look up what I could do with my my bachelor's degree there. And there's it's not a lot of counting. Counting sea turtles was on the list or not very much per hour, and I said, well, I better get this uh medical school thing, right? See what the next level is. Yeah. Exactly. So um, yeah, uh got my bachelor's degree um uh from SSU. Um worked on had a little bit of off time between then and applying for medical school, worked on my master's at Barrie University down in um South Florida. Did that for six months, um, and then obviously applied to medical school, got into medical school at Lincoln Memorial University, the bus college of osteopathic medicine. Okay, yes. Um it's uh located in Harrigate, Tennessee. Most people don't know where that's at. It's up in the Cumberland Gap area, about an hour north of Knoxville. Real small town. Yeah, yeah. Smoky Mountains, yes, uh, yeah, beautiful foliage. Uh absolutely gorgeous. Yeah, it is gorgeous scenery. Um, good people, hardworking people. Um, it was a new medical school at the time. Uh it was a huge blessing for that area of just bringing in clinicians and some medical knowledge into that region that was truly underserved. Yeah, and so yeah, that was uh that was a really good experience for me. I enjoyed my time there uh greatly. So so what did you think about medical training going through it? Um hardest thing I've ever done. Yeah, 100%. Um it's it's a full time. I didn't, you know, everything up till that point um had been relatively easy. You know, I was a good student. I I applied myself, but I didn't overapply myself, you know. Um had a lot of other things going on, hobbies and interests as one does. And it wasn't until really taking the MCAT for the first time that I said, oh, this is um this is this is something different. This is different. I rolled I rolled into my first MCAT. I'd been on a fishing trip for a week and a half with my dad in South Florida and came back the next day. I took the MCAT and while I'd studied, I did not study appropriately. Yes. And so um I realized, all right, this is a different, this is a different league than what we've we've been playing in, and um takes a different level of commitment. And uh I think that kind of kick-started it off. And yeah, medical school, I kind of treated it the same way. I made sure I had some fun in medical school, got to, um, for psychological purposes, I mean. Yeah, indeed. Um I think that's really important for medical students that are going through or just starting out. Like you've got to you've got to make sure you take care of your mental aspect because you'll just burn out too quickly.
SPEAKER_02Um read a book occasionally. Oh, go outside, yeah. 100%.
SPEAKER_00But no, it's most challenging thing I've ever done to go to medical school.
SPEAKER_02No, and and all of a sudden you're around a lot of smarter people very quickly that you know the things that you didn't have to worry about, all of a sudden you do have to worry about, especially because there's a subtle level of competition that's going on at all times that you have to kind of um dig into a little bit. And you may say, Well, geez, I don't really want to. Okay, well, too bad you're doing it anyway. You're forced to. You're forced to be able to do that.
SPEAKER_00You're competing for spots, you're competing for uh residency spots and um training sites and locations and uh experience. Everything is a competition at that point. It is.
SPEAKER_02Um we typically uh most of the guests on this podcast so far, we have made a decision between whether or not we're going to after our clinical years, the third and fourth years, um, whether or not we're gonna go internal medicine or surgery. Those are usually the dichotomous cut point. Um you chose something a little different.
SPEAKER_00I did. Okay. We went into pathology. Um I think my initial interest in pathology, whether I knew it or not, was in undergrad um at Ford State. I took a basic histology course. And why on earth would you take a histology course? No, I'm not even sure. There were other courses there. I'm not even sure I knew what it was. I don't know what it is now, as a matter of fact. But so uh it it was and it was fascinating to me to see things at a cellular level and kind of understand them. And and I was really good at it. Really good at it. I was looking at a microscope and it was natural, I was really good at it. I remember my last day in that course, um, and I was turning in my final and and my professor knew I wanted to was interested in medical school, and he said, Hey, he said, you might want to think about going into pathology. And I didn't really say a whole lot because I didn't even know what pathology was. I was like the guys at self-primes. Is that what it's I was like, oh okay, great, thanks. You know, and I and that was it. It was as I was turning in my final, and that was the last time I'd spoken to him. And um, so I left from there, and that was just in the just put that away and never even thought about it again. And then uh third and fourth year uh came around. Uh, I was going through my core rotations, a lot of stuff I figured out I liked, I didn't like. Um, I thought that I was gonna be doing, you know, I thought I would end up in ER, um, internal medicine, something like that. I feel like I've got the personality for that, that kind of thing. I like patient care, like patient contact. Um, and then uh I had my general surgery rotation. Um, it kicked my butt. It's long hours, very extremely demanding. Some of the most difficult work you will ever done to that point. 100%. I was getting up at three, four in the morning and getting there and rounding up. I mean, it was extensive. Yes. Um, and I remember I talked to another resident at the time and or another uh medical student at the time at the same foresight, and they said, you know, you might want to think about taking a pathology elective after this, you know. Those guys, you know, uh have a lot lighter day. They eat breakfast and lunch every day in the first round for an hour, you know, it's great. They look happy. And I said, Yeah, that sounds lovely. That's a good idea. Sign me up. So that's what I did. And boy, within about a week and a half, I was I was hooked. Um, I loved, I loved the work, um, loved learning about different things underneath the microscope. Um, and although I missed the patient interaction um to an extent, I still get a lot of physician interaction throughout my day. And uh interesting thing that I'll tell you, um, I remember uh later on in my fourth year, I can't remember, I was doing urology or something like that rotation. At that point, I kind of already made up my mind. I was late fourth year, I was gonna do pathology. And uh my my you know, my uh attending physician knew that. And I remember uh he put on my evaluation at the end of the month, he said, waste of a personality on pathology.
SPEAKER_02And I didn't know like, thank you, you know, is that uh I'm gonna try and put that a little bit more diplomatically and say that um most of the pathologists that we had from my medical school class, of which there were two, um they were pretty introspective, uh not very outgoing uh or or garish folks, um incredibly intelligent across the board, no doubt about that. Um but it seemed like the clearing call of pathology was you're gonna sit in a dark room and you're gonna be quiet.
SPEAKER_00Uh yes. And and I think that leads uh a good number of pathologists into that field. It's entirely accurate. No. Um I think people who maybe um struggle with face-to-face interaction with folks, um, it's a good place for them to get into people who maybe English is their second language that that that that is a good field for them to go into where they're not as comfortable and things of that nature. Um so yeah, there are a lot of those.
SPEAKER_02And it may um catch, and sometimes this gets a negative connotation, but it's really not meant to be. It's be meant to be more descriptive. Um some of the more spectrum disorders of our physician colleagues, they tend to thrive in these kind of environments where you can just really hone in and be focused on this thing, and they're quite excellent at it.
SPEAKER_00Yep. And and that's something interesting uh that's different, I think, about the group that I'm in now. Um, is you know, if there's there's eight, nine of us in this group, and I couldn't pick, and I'm I'm just saying this, like I couldn't pick more normal as you can get for pathology, more normal individuals that can hold a conversation with someone. I it trying to find that many people and get them in the same group for pathology is is unheard of, and I think that's what makes our group very well very good, is that we can communicate with our clinicians, you know, on the phone, in person, um, and that's certain that serves us well.
SPEAKER_02Well, this is one of the things that I really wanted to talk to you about and kind of um let loose to the lay public here that's gonna be listening, which is that um pathologists are physicians' physicians. They are some of the best friends of physicians because they're gonna get you the answers. Uh meanwhile, you are patient-facing and you are procedure-facing, they're gonna let you know what you messed up, which you didn't get. Um there's uh my wife has a saying from breast cancer biopsy, breast radiology perspective, which is you never want uh the biopsy specimen to say normal endothelium. That's those are those are not good things. Uh so um uh by the way, that means you you uh biopsied a blood vessel. So um you don't want to do that. Um so anyway, um it's just because to show you that I don't think patients think about their pathologist, and it's a crucially important field that we would not have the edifice of medicine that we have nowadays, would not be here as you know it if we didn't have our colleagues that were that were deciding pathologies.
SPEAKER_00100%. They they never see us. Um all of our work is behind the scenes. A lot of us like it that way and prefer it that way. That's why we got into the specialty. Um we're just a name at the bottom of a report, although it's probably one of the most important reports they'll get in their entire life. Indeed. And life-changing for them. Um uh but we're we're just that name. We never see them face to face. Um you still always try to keep that in mind that there's even though we're not seeing those patients, that there's a real patient on the other end of that glass slide that you're reading at that particular time in the other end of that case report.
SPEAKER_02Aaron Powell Yeah. And as of right now, vice versa, you you will say that there is always a human physician's eyes that are looking at your slides. Any biopsy that you ever get, any organ that has been removed, any sort of um uh blood smear that is being evaluated, there is a pathologist, and a a professional doctor that is trained that is looking at these.
SPEAKER_00That has seen many, many thousands of slides. Absolutely. And that's that's people ask me, what is a pathologist? What do we do? And the way I put it to friends and people who aren't in medicine is I say anything that they take out of the body during surgery or biopsy or anything gets sent to us, we look at it under the microscope, tell them what it is, did they get it all? Um, or did they leave some behind? Um, and basically anything that you send down to the lab, blood, urine, spinal fluid, everything, we're responsible for all of that that happens in in the lab. Yes. Blood testing, CBCs, all of that falls underneath our umbrella.
SPEAKER_02Yeah, and so um so to say that you are helpful here gives it short shrift. It is essential. Um, it is it is not just man, you helped make medicine better. It's medicine doesn't exist without you guys doing this kind of thing.
SPEAKER_00Yeah, we're um we're solving the ultimate mystery. I mean, I I I get to say that I've looked cancer in the face every single day, you know, and put a name to it. Um we don't know what anything is until it comes down to the lab. We have ideas based on imaging and laboratory testing and things like that.
SPEAKER_02Clinical suspicion on growth patterns, etc.
SPEAKER_00Yeah. But you don't know until yeah, but until we actually lay the eyes on it, we don't have a solid diagnosis. And that really, you know, the whole treatment plan and everything else is waiting on our diagnosis to happen.
SPEAKER_02Yeah, you know, from from the uh medicine and surgical side, I know that we had uh a saying which was tissue is the issue. Um you've got to get a slide down to the pathologist who's gonna tell you what's going on here. Ultimately, they can always decide what what the pathology was of a patient. Um so uh now so you go into residency. Now, um let me take one step back. And we had mentioned a word earlier that you had taken a course in called histology. Maybe you can describe exactly what histology is for those even medical professionals that don't know exactly what that is.
SPEAKER_00Sure. Um so I I let's just talk about how um tissue gets from the OR onto my stage, which is a part of the microscope that we lay the slide on to look at. Um so it's a little bit of an extensive process. I mean, you know, it it gets taken out, say you do a biopsy and surgery or whatnot, it comes down to us. We have uh either a pathologist or a pathologist assistant there that describes it. If it's a if it's a breast that comes down, we're measuring it, weighing it, um, a lot of times imaging it there in the pathology lab to find out where that tumor is so we know where to look and take our sections from. We're cutting it up, we're selecting little pieces of that tissue that we want to look at underneath the microscope. If it's a biopsy, we're obviously going to look at the whole thing. A mastectomy, we're gonna focus in kind of on that area of tumor. Um, and we're taking those sections, putting into these little plastic containers called cassettes. They'll get processed overnight generally. It's a dehydration process. And then the next morning that tissue will get embedded in uh wax, basically, just a wax block with that with that tissue in it. And we'll put it in a microtome and cut it into very, very thin sections, a couple microns thick. Put that on a slide, and then it goes on a stainer. It stains with hematoxylin and eosin. Um, it's the majority of our stains that we use most commonly, and it'll come out to me the the next morning and I'll take a look at it and uh and make my assessment from there. Um and and histology is me looking at it on the microscope on you know, low or high power, it could be anywhere from 2x to 100x in certain situations. And we're looking at the cells you know in their in their normal state in that particular organ or tissue, and finding out basically we're playing the first game we play is benign or malignant, you know. Um I heard you mention a couple podcasts ago, uh, you know, uh someone that's you know emergency, emergently sick, or someone you've got to keep an eye on versus uh something that's not emergent or something. Sick or not sick, yes, yes. And that's kind of that's kind of what we play as well, benign or malignant. And we kind of start there and then we you know tease it on down until we get to our our final diagnosis.
SPEAKER_02Yeah, so so we're using um we use individual stains that are going to bring out certain characteristics of whether it be cell walls or some sort of um identical uh identifying markers of the cell types that we're going to see there. There's some basic stains that we have. You have some more advanced stains, we can get into fancy terms, congo red and all this different stuff that you can bring out that that bring out pathonomonic features of the pathologic slide that you're seeing there. So you can tell me if this is going to be um a squamous cell carcinoma versus a basal cell carcinoma. Um and you certainly have your suspicion that looking at the gross specimen, I'm certain of that. Certainly the dermatologist or whatever physician that is uh excising this is is gonna have some clinical suspicion. But you ultimately are going to get that call because I would bet that you've been fooled before.
SPEAKER_00Absolutely. Um tumors are known for um, you know, losing uh, I guess, some of their defining characteristics, particularly as they metastasize or become more poorly differentiated, which is typically more aggressive. And so it's hard to tell sometimes uh where a particular tumor came from. Um if we've got liver not multiple liver nodules and we suspect metastasis, we don't have a primary site. That's that's up to us as a pathologist to try to try to figure out. Yes. Um imaging helps a lot, but you know, you can't image the whole patient right up front. One, you can't necessarily always get um true insurance to pay for it. And um so that kind of leaves it up to us with a tissue biopsy. And as you stated, um uh yes, special stains are increasing or incredibly helpful a lot of times, uh just patient history. Um just knowing if there's blood in the urine, of course, or all of those things. So sometimes when I'm stumped, I solve more cases just by picking up the phone and calling one of my clinicians and talking to them than I ever have with you know fancy stains and and other things like that.
SPEAKER_02Look, this is the thing that I um uh say oftentimes. Um I've got an unfair advantage. I get to talk to the patient. Correct. I get to hear, like, oh, oh, you've been feeling poorly over the past two weeks, two years, two months, two twenty-four hours. I mean, that changes everything right then and there. And so I get a clinical scenario that helps me on my cheat sheet quite a bit to try and figure out.
SPEAKER_00I get a two-word clinical history, you know, alternative. Millipatis with, you know, and they send me a liver biopsy. You know, great, yeah. We'll figure this whole thing out.
SPEAKER_02Yeah. And and but it but it does um uh suggest something, which is that we're always doing Bayesian statistics in our brain. We're always including the clinical scenario, and it's changing our um priors to kind of get honed down better on what is the higher probability of what's the underlying pathology. And if you can give probably a two-sentence history to your pathologist, they're probably going to be able to hit this a lot. 100%.
SPEAKER_00100%. Um, anybody that's out there, uh the surgeons, radiologists that are filling out our requisition sheets for pathology, clinical history is extremely key. Um I've had a couple clinicians in the past that didn't want to give clinical history because they didn't want to bias the pathologists. And that's just poor form of poor practice, okay? Yes. So I encourage you.
SPEAKER_02It's garbage in, garbage out. The more precise you asked. Well, let me.
SPEAKER_00Yes.
SPEAKER_02But but the more precise you ask your clinical question, the better answer that I can give you.
SPEAKER_00And I'll address that in my reports. If you put a question that what something that you want me to rule out, particularly on a case and it's in my clinical history, I'm gonna make sure that I address that in my diagnostic line and tell you that it's there or not there or that I looked for it.
SPEAKER_02That's right. So So now um so let's go back just a second to the training because now you've decided to do residency and pathology. Yeah. Not everybody in even the medical field knows what a pathology residency is like. So tell me about what this is.
SPEAKER_00Um so I'll give you a little bit of my experience. Um it's four years. Okay. Um there's no intern year, so it's not like some other specialties where you're kind of just, you know, working as a just an intern for a year, kind of get your feet wet and everything like that. No, you're cast straight into it. And it is completely different than medical school. Obviously, we're we're using some things that we learned in medical school, but we're not going into internal medicine. No, we're we're looking under a microscope, and medical students, um, particularly, you know, up to this point, aren't getting a lot of training on pathology. At least that's unfortunately I didn't get great training in pathology at my medical uh institution. And so it's almost like starting over again. Um and everything's new. You you feel like you've you've got it, you're you know, done with medical school, you're ready to go, and then it's it's kind of the almost defeating. You're starting over again. Yes. And so that's uh challenging for a lot of folks, is kind of doing that, starting over again. Um my first uh uh rotation was three months in autopsy. Um and uh autopsy was one of the most physically demanding rotations that we have for obvious reasons, and that's what a lot of people think that pathologists do all day. They think that we we we do autopsies, of course. Yes. Um I did my 60 or 70 in training, our requirements were 50. Um, and that's all I ever plan on doing. I don't plan on doing it anymore. Like as long as I can help it. Exactly.
SPEAKER_02Um I delivered two babies in medical school. That's it. I did it.
SPEAKER_00Um and so uh I think autopsy was actually probably the perfect rotation for me to start out on, um, is because it it gave me a good sense of what normal looks like. Yes. And that's the thing with pathology and really any specialty is getting your in of a hundred, a ten, whatever it is, however much you need, but knowing what normal looks like. Yes. That way when you see something abnormal, you may not know what it is. You may yes, but it doesn't matter. You can't just find it to say like this not normal. Yes, that's right. That's right. And uh it gave me a good sense of what normal was. Um I also got to see some um really good cases of diseases running their course. Uh we had a uh contract with the state of Alabama uh with the prison system. Any any prisoners that uh were not homicides, suicides, um they came to us. And so as you know, medical care is not great in the prison system. And so we would get to see these disease courses just kind of run rampant till they're end. Of course, of course.
SPEAKER_02And um so so full-on tuberculosis. Uh correct. Uh tertiary syphilis, uh really in-stage stuff, yes.
SPEAKER_00Yes. That you read about in textbooks, but you never hear it. People never see, and I'm getting to see it, you know, every day.
SPEAKER_01Yeah.
SPEAKER_00And uh yeah, so that was my first rotation was um autopsy. And then we're doing a number of other things. Um we're learning about the lab, so we're doing general chemistry, uh, blood banking. Um, we're going over and doing cytology, so we're looking at you know, poral fluids and CSFs, SIDs, yeah, yeah. Absolutely. So um and cytology is a whole different animal in itself. You know, um, most of what I look at is whole tissue slides where we're getting to see those cells in their setting, in whatever organ you know they came from. Cytology is different. Cytology is pulling those cells out of context, out of that tissue, and they're just kind of free-floating, and you're determining whether or not they're malignant. You can't tell if they're invading in the tissue because there's no tissue there. There's no stroma there. So you're looking at the, you know, looking at the nuclear characteristics, the cytoplasmic characteristics of those cells, and trying to determine are these good cells, bad cells, um, and then what do I call them?
SPEAKER_03Yeah.
SPEAKER_02And so and and so uh, I mean, on the pathologic side, uh, on autopsy um side, it this is this is big picture. You're taking organs, you're looking at them, you're weighing them, you're seeing a lot of normals, because even if somebody's got a degenerative brain pathology, you can still have a normal liver with that. So you're getting a lot of your denominators growing large.
SPEAKER_00Yeah, we had our standard sections that we took on every single case, whether you know they had heart disease or not. We had our standard sections we were taking from the heart every single time.
SPEAKER_02You're gonna look at the aorta, you're gonna see if there's any sort of atherosclerosis. Yep.
SPEAKER_00And so we um we, you know, you get to learn a lot about what nor normal looks like.
SPEAKER_02Yeah, normal may not be so normal. Um, you know, I I'm sure um the incidence of fatty liver disease has increased just as our uh metabolic health has decreased significantly. So so normals may not necessarily be healthy. Those are just uh so so you you you're learning on the fly here in residency as we all do. Um yours is a little bit more intense under the micro. I mean, the there's something about sitting for nine hours and doing something where you're just looking under a microscope. And I mean, you have to train your eyes and your back and your other things that like whereas we were moving around and seeing patients and interacting and stuff, you're just dark room silence, I guess. And absolutely.
SPEAKER_00Um not as dark as a room as radiology. All right. Yes, exactly. Um yeah, definitely a lot of sitting underneath the microscope. There's a funny picture out there of a uh first-year resident, and it's got their head, you know, it's just a normal head, and it slowly morphs into the form of a microscope as they progress through training. And that's absolutely true. Um, we're spending a lot of time under the scope, making a lot of very important decisions with every single slide that rolls across, you know, your life-changing decisions for folks. Um, and so you're you're mentally, you might maybe not be physically tired, your back might hurt from bad posture or something at the scope all day, but sure, mentally you're exhausted by the end of the day. My wife asks me sometimes, you know, we'll pick kids up from soccer practice in the evenings, she's like, Where do you want? You want to grab something to eat tonight? Sure. Where do you want to go? Well, I just I'm tired of making decisions. I make 80 decisions today. Oh man. And and I am tired of making decisions, so uh I'm gonna let you have this one, honey.
SPEAKER_02I will definitely say uh to my wife after days like that of uh don't expect anything smart coming from me here. Okay, I just I'm just here to exist for a little bit and space out.
SPEAKER_00So um But they um one thing I wanted to mention was uh they did an interesting study one time. Um you know, they they followed uh residents, well, they followed medical students, residents, and then senior pathologists' eyes, eye movement under the scope. Oh yeah. So multi-headed scopes, they were tracking their eye movements. And you know, the the senior pathologist is you know putting the the slide on the stage and they're the ones driving, you know, showing moving the images around. And uh they were following the medical students' you know eye movements and they're they're jumping all over the you know, left, right, left, right, up, down, up, down. It's kind of kind of a similar pattern with a residence, but maybe not to that degree. And then you've got that senior pathologist whose eyes are just kind of locked in the middle of the of the field, and then as pathology scrolls across the screen, their eyes are automatically kind of drawn to it. And they um so they followed their eye patterns, and then also how long it took them to pick up on that pathologic area. And of course, as you would expect, you know, there was a greater distance in time depending on the you know amount of or less training that you had. And so um, that was a very interesting study, and a lot of it is kind of um what we do is pattern recognition, it's knowing what normal is, what you can let go and forget about and turn your brain off, and then picking up that one little area that's that's abnormal.
SPEAKER_02This is the exact same thing with EKGs, echoes. You put a normal EKG in front of me, my eyes almost gloss over. It's it's like I'm looking, but my brain isn't really, and then all of a sudden something will catch my eye as abnormal on an EKG, and immediately I go, wait a second, that's not supposed to be there, and my brain switches on for that kind of thing. Echoes, there's nothing in the world easier to read than a normal echo, right? But then something comes and catches your eye, and you're immediately kind of jet into position.
SPEAKER_00So it's it's pattern recognition. And that's what it is, pattern recognition. And they did a study, we had a joke uh in training because it had just come out at that time. There were uh they were a study where they had pigeons reading, I believe it was breast or prostate or something like that, and they were flashing these uh images up in front of pigeons. And if they clicked a yes or a no box or a malignant or benign thing, they would get a reward, right? And what they come to find out was the pigeons were really good at it, but they were picking up on the patterns of this infiltrative tumor on these images, and you know, uh, and we can delve into this later, but they eventually found that while they could distinguish the patterns on those images, which is a lot of what we do is pattern recognition. Uh, you know, if you change those images out to something different or a little more obscure, they you know they were missing those. So obviously we weren't losing our jobs to to pigeons. But but just the proof. No, no, no. Uh the bait fundamental basics, a lot of what we're doing is just pattern recognition as we're going through our cases throughout the day, picking up on that abnormal.
SPEAKER_02Now, uh but, and I really appreciate this, uh, pathologists do have that physiologic background. Yes. They do you so you're seeing this through a lens of understanding um, you know, uh pathophysiology, not just looking at a slide and saying, oh, well, I see some sort of uh you know multi-lobed uh neutrophil or something like that. You're kind of understanding the idea, oh, I I can make the connection between what that means and why the patient's short of breath.
SPEAKER_00Absolutely. We see the endoscopy report or something, they you know describe like a little nodule or type, you know, duodenal area or something like that, and I look at it and I see foveal or metaplasia or something on there, and I say, oh, this is correlating with exactly what you're seeing. Like they did see something, and it's it's nice. Yes, yes, exactly. And I get to kind of confirm that, you know, and I'll and although that's completely benign, there's not a really whole lot to do, worry about, I'll put that in my report, you know, and just to let them know, like, yeah, you saw something, then this is exactly this is exactly what you saw. And um, I think it's also very important. Um, and one of my mentors uh uh at UAB where I I did my training uh in residency, um, he was very good at telling me, you know, what you needed to worry about. You know, you see a lot of stuff that may not be normal, but it it's not malignant, it's benign, it's some sort of metaplasia or whatever. And sure, you could spend $300 worth of special stains working this up and putting a name on it, but it's not gonna it's not gonna change the way that they manage the case. And uh I think he had a great influence just by telling me that and practicing that way on how on how I I practice. Um and it's knowing it's knowing how your surgeons, your clinicians are gonna respond to what you call something, what they're gonna do with that information and what they need to know. That's right. And that is extremely huge. And a lot of times it varies from clinician to clinician on what they're expecting and what they want to know. And so having a good relationship um, you know, with a clinician. What are we gonna do?
SPEAKER_02Ultimately, where the rubber meets the road, is this gonna help the patient at all if we start to do a lot of these things? Uh you know, um, I had a mentor at Fellowship who was talking to me about echoes and said, Look, all of the academic bloviation that we have about this entire thing, there's four things you can't miss. Right. Don't ever miss those things, and the rest doesn't really matter. Yes, you can talk about it. Yes, you can be more accurate than somebody else with regards to that, but you know, the whether the E prime lateral is 0.6 meters per second or 0.7, this is not gonna make a hill beans here, okay? So don't lose any sleep over that kind of thing. So so there's a lot of erosimilitude in the way that we're practicing. It's that there's still a clinical element, there's still a patient behind this that is having some sort of presumed complaint. Well, there's screening, of course, that can come along too. Right. So so you do four years of pathology residency at UAB. Yes. Did you consider doing fellowship after I did?
SPEAKER_00I did a uh fellowship in surgical pathology at UAB. At UAB in Birmingham, yep. Um both of my kids were young. Uh my second daughter was just born, she was less than a year old. Okay. My wife uh had her job there that she was absolutely love, and I said, this is a this is a good institution. It is. Um I I it the volume's here, the the the the kit the cases are here that you need to see. Like there's no reason to tertiary referral center is getting a lot of pathology, yes. And I think uh it was beneficial for me actually to stay there because my program director had a lot of trust. I built up a lot of trust with him as a resident. I I I guess I was a good resident, he trust me a lot, and so I got a lot of responsibilities in fellowship that I don't know that I would have gotten in other places, the trust. And so um I was handling cases, you know, like I was an attending position. And obviously I had plenty of people I could go to if I was worried or whatnot, but um I I had my caseload. And so when I got out and I was practicing on my own, boy, when you hit that button the first time and there's nobody looking over your shoulder anymore, you're you're sweating bullets. And and that helped, I think, transition and ease me into that a little better.
SPEAKER_02I was gonna say, you're making the decisions then, and you're all of a sudden feeling the weight of, oh, we we I need to really know what I'm talking about. You know, I'm gonna scan this uh slide a couple more times.
SPEAKER_00Yeah, we don't get a second chance generally in in pathology. Um if if we see if we send grandma home and say she's all clear and then she comes back in six months and she's got metastatic melanoma to the brain, like that's that's on us. Yes. If if if if we if we tell grandpa that he's got you know prostate cancer and he goes and gets a prostatectomy, and we give we cut that prostatectomy, we don't see anything, that's a big that's a big no-no on us. So it's uh it we don't get second chances.
SPEAKER_02Yeah, coming out into practice, it fell um some of the more simple things like is this person cleared for surgery? All of a sudden I felt a higher weight of like, of course. Well, geez, I don't know. Maybe we should just go and cath everybody. But I mean, like there's there's all of a sudden, wait, how confident am I really in this? And that really that that puts your feet to the fire for the first time that you're not quite ready for. Now, what are you doing in a surgical pathologic fellowship that you weren't doing? What was the additional training there besides a little bit more autonomy?
SPEAKER_00It was um a heavier caseload, um, more time in general surgical pathology. Before obviously we were mixing in, you know, autopsy and blood bank and you know, different areas like that. This was focusing more on the bread and butter things that are coming down from surgery, our breast or GI or ENT and Whipples, you know, all of those kinds of things. So really focusing in on tissue diagnoses, and that's um full year of that.
SPEAKER_02You know, um let's let's also talk about that um, you know, pathologists can be on call as well, and not just the forensic pathologist, but surgical pathologists uh are on call. And maybe you can talk about what exactly you're doing when you're on surgical pathology calls.
SPEAKER_00Sure. Um so um our call is a little different than other specialties. Um typically it's a little lighter in training, obviously, bigger institution, you have more responsibilities, uh, much more involved. Um here in private practice, that's changed a little bit. Um, a lot of times what we're on call for, we take weeks of call at a time in my group. Um there's eight or nine of us, so you know, we're taking it once every eight or nine weeks. You almost forget that there's call until it rolls around. Until it rolls around. Oh, yeah. It's um but the majority of it um for us is uh late cases in the OR that are running past five o'clock. You've got your guys there that have been covering that OR schedule all day and they're they're tired, they're ready to go home, and there's some late cases. And you come in and relieve them. Um that's a good portion. The other portion is uh honestly is um tissue procurement, organ harvesting. Um you know, they're those cases typically happen in the middle of the night. Um, and what that is, they're wanting to transplant organs. Yes. Um, and they're taking a little biopsy of those organs. Usually it's liver and kidneys, and they're sending them down to us, and we're doing a we're making a down and dirty slide. It's an interoperative consultation, also called a frozen section. And it's just a quick 20-minute we can make a slide to look at under a scope and give them a good idea on if that organ is healthy enough to transplant into someone. And so those usually happen in the middle of the night because they're trying to fly those organs generally cross-country or somewhere else, and you want that fresh OR team that's coming in first thing in the morning to transplant those organs. So those aren't fun, those happen in the middle of the night. But um No, they aren't. It though those calls are those calls are not they're they're not um, you know, every day. Um, and uh, you know, some weeks you get lucky, you may not get a call. But we're not sleeping at the hospital like some other specialties or uh or delivering twins in the middle of the night or back to back or anything like that. So um there's a lot of there's a lot of aspects of pathology that's very nice as far as just having a a family knife, uh family life and good quality of life and home time. And that's honestly a big part of what led me you know into pathology as well. So for some that can't be over.
SPEAKER_02Medical students to to think about it.
SPEAKER_00100%. Um last night, for instance, I got off work, I went home, cooked dinner. I played soccer in the front yard with my two girls for about an hour, hour and a half till it got dark, and did some farm chores for my wife, and then you know, came in the house. Like, but that's a normal afternoon for me. It wasn't it's almost like a normal human. Right? It's nice. Okay. So uh yeah, very blessed in that aspect.
SPEAKER_02Um well, I do think you brought up some interesting things that I just like as a medical aside for the the lay folks, is that um, yeah, most organ procurement is done in the middle of the night. That is virtually across the board. And again, this is for the transplant surgeons. It's it's a different transplant team that takes the organs out than are to put the organs in, as they are going to be shipped out to various different places in a somewhat limited radius from the donor. Um and it it's always two, three in the morning. We get the emergent echoes from our side of we want to make it. There's always a delay. There's always a delay, there's always like that. And and the heart, by the way, is always the last one to go because it has to perfuse the other organs as going. So it's anyhow. Um but those are important parts of our job. It's you know, it's it's necessary to kind of be able to facilitate this organ donation and harvesting to help as many people as we can. So um so it's something that we take seriously and have a lot of reverence for. Um the other thing that um I wanted to kind of harp on is that when you're doing um on call for surgery, you're also looking at margins. And maybe you could speak to well, both the physicians and the lay audience about what that really implies.
SPEAKER_00Sure. So um a lot of times during surgery, um the the surgeons in there and mm maybe they can only get into that specific area one one time. They're there, this is their shot. They need to know if they need to take this mass out, leave it what it is. Um, and so what they'll do is they'll send out a little tissue fresh piece to us in the lab, and uh we'll uh make a quick slide out of it. And it's called a frozen section. Uh we take that tissue and we basically uh instead of embedding it in wax, we put it in a different substance that kind of we we freeze it at very low temperatures, it turns hard and it kind of acts as a block. We put it again on the microtome and cut it into very thin sections, and then we stain it right there. This whole process from the time the the tissue hits our laboratory till we give them a diagnosis is about 20 minutes. And that's because patients generally under anesthesia and they're they're on the table. So the surgeon is waiting there.
SPEAKER_02And he's waiting impatiently. He or she is scalpel sharpened and is waiting right there for you to say whether or not Yes, what this is. Good or bad. What this is, yes.
SPEAKER_00And so a lot of times, you know, we'll call them back and say, hey, you know, this is this is tumor, you know, this is what it is, and uh and then they'll go ahead and resect it. Um other things that we do for those interoperative consults is a lot of margins and things like that. Um, those can happen on breast cases sometimes where they want to make sure that they've gotten completely around the tumor. Um sometimes breast cancers uh you know are multifocal. Um sometimes they have little fingers that kind of trail out from the center of the tumor, and we want to make sure we're not leaving any of that cancer behind. And so they'll send us margins and we freeze them, look at them, and tell them, hey, you know, you've got it all. That's right. Um, and uh, so that's a big part, and it's a big deal because you know, you're you're on the hot seat, you're on the spot, you're guiding that surgeon's hand, essentially. That's right. Um, and so we're we're we're leading them at that point.
SPEAKER_02And uh the surgeons are dependent upon you and your interpretation of this information. Yes. Now there's also um, you know, some element that you're taking a three-dimensional structure and you're cutting this into two-dimensional slides. So, you know, I'm I'm sure there's plenty of sayings about this from a pathologic perspective, but sometimes you could hide a house in these different dimensions that uh, you know, uh there's got to be some margin of error of things that you're not getting to point.
SPEAKER_00We call it tangential sectioning, or sometimes, you know, it's not facing up or or or laying horizontal or anything like that. It's kind of sectioned tangential through maybe the skin surface or something like that, and it makes it uh very challenging to read. Um, levels are our friends. So when I mean by levels, is we've got that block of tissue, they've taken their slice off of there for us to look at, and I say, hey, cut down deeper, take me some more, and see if we get through this. Give me some dimension to give me context. You can it may not look like it's quite invasive, might look like it's in site two or something like that, but you're a little suspicious, you start getting levels, and you can follow that one little area and say, Oh, yes, it turned into something invasive, you know. So, yes, you kind of uh section.
SPEAKER_02Well, and you certainly you feel badly for the patient in that sense, but you also feel better about yourself of saying, like, I'm giving you true, accurate information about where this is. Is this is this escape the capsular enclosure of this particular uh pathology?
SPEAKER_00Yeah, yeah. Um you you all we always keep the patients in mind, but you know it's it's interesting because uh it's it's not uncommon for someone to walk in my office. And say, hey, hey, Scott, I've got a really cool case to show you. And cool for us as pathologists is completely different than for the patients, you know.
SPEAKER_02Be very leery when a cardiologist says interesting. Okay. Right. Exactly. Something uh not good may be going on. Yeah.
SPEAKER_00Exactly. And so um yeah, you know, and we sh we share cases quite frequently, you know, because pathology is an it's an art, really. Um we're we're we're you know, we're looking at these these tissues underneath the slide, and they're stained. It's almost the way I describe it to people, it's it's like looking at a painting, like an abstract painting. Um, I might see something one way, you know, and I show it to you, and you see something different in this abstract painting. And so um a lot of times I sh I share cases with my colleagues and just make sure, you know, I'm barking up the right tree. We're all on the same page here, um, particularly for you know malignant diagnoses and things like that, um, getting a second opinion. Um and so the last thing you want to do is you sign out a case and it go to a bigger institution, maybe somewhere they're gonna go get treated, and they've got a room full of 17 pathologists looking under a multi-headed scope. Of course, with everybody in their own specialty, and they say, Oh, why didn't Dr. Taylor from Tallahassee get this? You know, when we're the ones taking grenades every day, day in and day out. So um it's always good to get a second or even a third opinion in some cases or more of your colleagues.
SPEAKER_02Yeah, and and and being humble about that, because you you you you we all get humbled. You know, the things that we know for sure. Uh you know, I'm sure you've you've thought for sure this is uh classic uh breast adenocarcinoma and it comes out squamous cell, and you're like, I would never have thought this. But it's gonna change the management too.
SPEAKER_00100%, yes, absolutely, absolutely. And I and I'm you know, our goal is to always get the right diagnosis. Even if it takes longer, and our turnaround time doesn't is it met for that particular case, doesn't matter. Even if we lose money on the case, we got to put in more blocks, we gotta do a whole bunch of stains, we've lost money, doesn't matter if we want to make sure we get the right diagnosis. And if that includes sending it off to one of the experts and and doing that, or sending sometimes a clinician will call me and say, Hey, I I I don't want to disagree with your diagnosis, but it doesn't quite fit the clinical. Happy to send this off, you know. Yeah, and hey, if if if it comes back as something different, I'm I'm happy, I want it right.
SPEAKER_02I will change my algorithm too, because I'll learn from that too. Exactly. Yeah, and I'm glad you brought up something because I wanted to talk about it, which is that the subjectivity of pathology interpretation. I mean, there's some subjectivity in virtually everything that we're doing, you know, some things that probably aren't going to matter. But so let's take uh maybe some hematologic slides. Um, you know, the different concentrations of pathologic cells, so cells that are growing abnormally, um white blood cells that are growing abnormally, is this 10 on the slide? Is this a hundred? Is this a thousand? I mean you're you can count seven individual cells. You're not counting seven hundred. No. So you have to get a kind of gestalt for that. Yes. And and so um maybe can talk a little bit more about it.
SPEAKER_00Yeah, and so and that comes into where some of our sub-specialty training does, you know, pla comes into play uh for pathology pathology. Um, you know, we've got uh two heme paths in our group. Um and so when I get one of those cases and I get the lymph node here with these with these cells in it, I'll bring it to them and say, hey, what do you you know, what do you think the percentage of these cells, what's this kappa lambda ratio here, do you think, or what else? Yes, yes, yes, exactly. Uh because they see they see more than I do, and that's kind of their particular area of specialty. That's right. And so um, yeah, you kind of get a good benchmark. But it's interesting, and one of the interesting things is pathology is you're always kind of resetting and recalibrating yourself on what you're what you'll call, what your thresholds are for things, and it changes. It can change some people, you know. The joke is sometimes you ask me this tomorrow, and I might give you a little bit different answers. But it does, it does have these ebbs and flows, and some of that is um, you know, your internal consultants, other people in your group that you bounce ideas off of, you kind of see, oh, well, maybe I'm you know a little undercalling this particular thing, right? You bump it up a grade, or you get some feedback from consults that you send out to you know expert institutions, and they you know, maybe you're overcalling something a little bit, and so you're always calibrating a little bit, and that's why it's it's kind of an art form, it really is. Yeah, it is.
SPEAKER_02And and you may think, or at least the lay public might think, that you would well always overcall. I mean, you always want to make sure, but that's not because you might be handcuffing someone to chemotherapy, six cycles of it, 100% that they would never have clinically had anything done to it. So so it's you you really want to Goldilocks this. You really want to try and hit it right, not over, not under. I mean, if you see one seven-lobed neutrophil, are you gonna jump up and down and call that as opposed to if you see a slide full of it?
SPEAKER_00I I used to have one uh uh clinician who would always tell me, All you all I need to get you is one cell. And I would say, no. I would probably I would really like more than one. Preferably more than one if you could.
SPEAKER_02If you could do that for me. Yeah, you know, and I think that there's probably an element of there's a difference between uh board question pathology and actual where the rubber meets the road. Because because there's probably the like, well, yes, you should aspirate every cyst and send it for cytology. When at the end of the day, that's got to be incredibly low yield whenever you do that, and you're going to say, uh, it's you know, uh random bits of fluid here. I can't really tell you anything about what's going on here.
SPEAKER_00Right. Yeah, absolutely. Um, yeah, if we if if we sent every specimen that we took out, we would just be overwhelmed, you know. And there's some, there's some, and it's interesting, we talked about that. Um, there's some places where they've a lot of what we do is they do tonsilectomies or something on these on these young children, you know, and it's like, well, it's hypertrophic tonsils, you know, there's really not a lot of yield from us looking at them under the scope unless they're suspicious for some sort of lymphoma or something like that, you know. And so the the yield is very low. And so I feel like there's some specimens that a lot of what we're doing is just confirming, yes, you took off a toe, you know.
SPEAKER_02Yes, it is a toe. Confirmed one toe.
SPEAKER_00And so carry on. There's there's there's a lot of that. And and then there's some places that don't send a lot of the amputations anymore because it's you know, you've got these big, bulky specimens you've got to keep for a certain period of time. You've got to worry about freezing them and then um, you know, processing them and having the PAs and all the resources that we pour into those specimens um for pretty low yield, you know. Yeah. Um and so yeah, uh a lot of clinicians, you know, have to make those judgments on what they want to send down to us and you don't just want to be spinning wheels.
SPEAKER_02Correct. You really you want to be helping patients and colleagues. I mean, you want to you want the things that you're saying here to be uh helpful in some way. Um not just Yay, we got a toe. Um so um now um do you have any stories just off the top of your head of things that were totally incidentally found you did somebody remove did a hemicolectomy for something totally benign and you find a sort of thing?
SPEAKER_00Oh sure, I have I have one um just yesterday. Um uh I had signed out, uh they did a sigmodectomy on a patient uh a couple months ago. Or the colon. You've removed, yes. Older gentleman. And he had ischemic colitis, clear cut, um, didn't see any tumor, nothing, no funny business, anything like that. Um, straight ischemic colitis. Uh put an ostomy in and everything else. Um he uh had some dementia and some things like that. Family was taking care of him, and he kept spilling, you know, the bag and everything else. And so they went ahead and did the ostomy takedown just to help help make him a little bit easier, yeah, help easier to manage. And so um I'm looking at that ostomy site and some donuts that they had sent me. Okay, and um, you know, those are run-of-the-mill specimens for us. That's you know, 30 seconds, 45 seconds, yeah, bread and butter type stuff. You know, no clinical history of anything. Well, I saw some uh some atypical cells, very, very faint atypical cells on the cirrhosal surface there, ended up working them up as metastatic cancer of unknown origin, um, and use some of my special stains. I've um uh two of them as a PSA, PSAP. They're known for marking prostate, um, and they were positive for both, and so metastatic prostatic adenocarcinoma.
SPEAKER_02He had metastastom.
SPEAKER_00And so I have to call up my clinician who thinks he just did a routine ostomy takedown and say, hey, this patient's got metastatic adenocarcinomas, prostatic origin, at least that's what it's staining like, you know, you might want to check them out. And so um my clinicians uh hate seeing um the BSA is 7D, yeah. Yeah, it's a weird it's a weird feeling because I call my clinicians and they answer the phone and they're always nice to me. Of course, of course. But they know what's coming, you know, like what which which one not? You know, especially when it's unexpected. They understand, okay. I took I took a biopsy of a colon mass and I sent it to them. Like they expect that call. But when they don't necessarily have anything in the back of their mind, and here I am calling, they do not, you know.
SPEAKER_02No, not a good feeling. And so to kind of translate for that, that was um so um this bowel disease was not getting good blood flow. We call that ischemia. And so um ischemic, bowel, mostly anything ischemic is going to die. And it's gonna die um quickly and painfully and septically, and it's it's gonna go down. So the surgeons removed that, they took that end where that section had been removed and moved that area to the abdominal wall so that they could defecate through that area, and then as they put that back into place, reconnected it, they found that there was actually cancer there that was of a metastatic origin.
SPEAKER_00And I pulled that old, that old uh sigmodectomy case. I pulled it, I reviewed it, made sure we didn't miss anything. I didn't miss anything. Because it was my case, I didn't miss anything. I brought it to one of my partners and said, hey, look at this. I just found cancer in this other this recent specimen, make sure I didn't miss anything in this one, had them look at it too, and you know, confirm that no, in fact, it was not, you know, not there. Yeah, and incidentally.
SPEAKER_02You know, again, you're not doing every you're not slicing the entire specimen. You're not taking every single part. You can't do that. So there is some margin of error there. And you know, this had this had come up with um some later questions that we'll cover of um Jeremy Sunseri during his podcast about um um sentinel lymph node biopsies. And you know, you're getting four or five micron thin tissue-thin slices. That's incredibly small, that's uh thousandth of a millimeter. Um, but you can still miss some cells that could be there.
SPEAKER_00100%. I you know, uh sometimes I pick up on metastatic disease in these lymph nodes, and you know, you might pick up six cells, and you're like, if if if that if if that histotych would have turned the wheel and faced that block in a couple more turns, these six cells would have been gone. They would not have been here. And I would I wouldn't have been able to make this diagnosis. And why we try to sample everything really well, and we put in all of sentinel nodes and things like that, you you you just there's you physically can't look at everything. Every cell, we cannot look at every cell. We would never get through our days for order. Yeah. Um, and it's the same thing with our bigger cases. We really rely on our judgment as pathologists, our um pathology assistant judgment on where to what sections to take, what's going to be pertinent. And it's important for them to know what we need to sign out the case, margin-wise, is there capsular invasion in this uh thyroid nodule? We rely on them heavily to lead us. So it's really a team effort from the time, you know, obviously in the OR, but when that specimen hits the door from the from the PA to the histotech to everybody, it's a team effort on trying to make sure we get that right diagnosis.
SPEAKER_02Yeah, uh, and and also are you taking into account things like the genotype of the actual cancer now? Because there's some some further advanced technology. You know, there's certain tumor markers, genetic types that will suggest that these are metastatic when you're looking at the synthetic live node biopsies. That's what we're doing.
SPEAKER_00Absolutely, yeah. So um there's a lot of different testing that we can do on these tumors now. Um, and yes, it can tell things like what is their risk to metastasize over the next um 10 years, or or is this is this cancer going to behave poorly? Um, and things like that. So, yeah, there's um a lot of that different type of testing um uh that that we can do on these tumors. Um, and that's part of something that we have to keep in mind when we are um processing these specimens and working them up to get to a diagnosis. You know, if we order too many stains or have that that tech cut into that block too much and we lose that tissue, then we can no longer do that extra testing for treatment purposes. What drugs are they is this tumor gonna respond to? Great point. So um we're really a steward um in trying to preserve tissue as well for that type of testing so that patient can get the appropriate um care that they need.
SPEAKER_02And who knows what's gonna come out next month that's gonna require 100%.
SPEAKER_00Something that I've started to see creep into um certain aspects of pathology is um tumors are starting to be classified more and more on their molecular characteristics. So um used to, and what it's been forever, is we look at we look at the histology of the tumor and we kind of grade it, we classify it. What does this look like? Exactly. Yeah, and and even before we had special stains that might be able to tell us where these tumor, these tumor cells originated from and stuff like that, older pathologists had to just rely on histology. But now we're getting to the point where we can do molecular profiling for these tumors. And there are some instances, particularly in um uh some of our uh hematopathology and neuropath, um, where these tumors are classified strictly on their molecular profiles. If they have a certain mutation, it doesn't matter what this tumor looks like, this is what you call it. Yes. Whether it looks completely low grade or not, this is what you call it. It's a WHO grade four tumor.
SPEAKER_02And so um which is gonna dictate your treatment plan or the treating physician's plan of which kind of aggressive chemotherapy they're gonna go for too.
SPEAKER_00And it makes it challenging for some of us in practice settings like mine, where maybe we don't have access to some of those molecular diagnostic uh uh testing modalities, and so we have to you know send it off to someone who does, you know, at a bigger institution, Gainesville or somewhere like that. And so um it's challenging for us. We can tell the clinician, hey, this is what it looks like histologically, but until we get this testing back, like it could bump this up. Right. And it can be called something different. And so um that makes it a little challenging, and it and it it makes us think of potentially if that's what we get to one day, where we're basically taking this tumor, uh, lack of a better term, just grinding it up in a grinder, running it through a machine and saying this is what its molecular profile is, this is what this is. This is what it is, you know. Right. Um hopefully it never comes to that because it might put me out of a job. I think we're a little ways away there.
SPEAKER_02But yeah, but I mean um the world gets some benefit if that's correct. This is what I say. If I'm put out of a job, it's a good thing. The world's getting healthier, yeah. So that's good. Um but it also goes to show you that like it's it's I have the benefit of being able to look at things like an echo or a coronary angiogram, which shows me some physiology. I can get some physiologic look at this. You're getting purely anatomical data. It's hard for you to get an idea of how this is acting. I mean, you can you can kind of interpolate maybe what that is based on how it looks and if it's invading the capsule or something along those lines. I get to see it actually doing live. The genes maybe bridge that gap because it's suggesting the only way it could behave metastatically is if it has these genetic changes.
SPEAKER_00Yeah. And well, uh it's mentioned it's funny that you mentioned that. Um, one of the things that we use a lot of molecular testing on is um for thyroid ethanase. So it's a cytology specimen, you're looking at cells, they're not in tissue, and you're saying these cells look uh abnormal, atypical. But you can't call it papillary thyroid carcinoma, it doesn't have all the characteristics or whatnot. So you call it atypical and it'll get sent off for molecular testing, and it will say, hey, this has a 25% chance of being malignant or 75% chance of being malignant. And so the clinician can get that report back and you know talk talk to the patient and say, Hey, do you want do you want to have a lobectomy here? Or what do you want to do here? Do you want to FNAD again in a couple of years, sit and watch? And so they can kind of have those types of discussions, you know.
SPEAKER_02That's a bespoke patient experience there where we're talking about not about thousands of patients, about you. Yeah. What do you want to do here? And I think that that really enhances it because you know it takes us a little bit outside of the bell curve and starts to talk about no, wherever you are in this, we're gonna make this specific to you. Yeah, and I've long since said that about um uh a human pharmacome project where we can take medications and get them specific for you. That that is really gonna be uh a boon to medications uh whenever we can get there. So um well, look, I could go on and on about the pathologic sides of things, which is really interesting. But we're gonna change things just a little bit here and and and ask you um what is the biggest issue you think that is facing your particular fields over the near future?
SPEAKER_00I think one of the things, uh a couple of things that are kind of on our horizon. Um as probably I'm sure a lot of your prior guests have mentioned, AI, you know, that's kind of the tip of everybody's tongue right now. That's right. Um and how it's gonna play a role in our field. Um I think it's it's gonna be a little challenging uh in our field, just because like I said, it's it's it's an interpretive. We're interpreting paintings, you know. Um and so it's gonna be really hard to train uh a machine that to do that or a program to do that. You know, I had fun with uh Chat GPT when it came out. I took a picture of under my scope of some of some of a breast, you know, slide some benign breast tissue and sent it in and say, What's this? And it tells me, Oh, that's some good-looking prostate you have there. Yes, yes. And I said, Okay, I think I'm good for it. I'm all right for right now, right? Right? I think I'm good. And so um, you know, I think that it might have its role in certain areas. There's some things that I think can be done. Uh just for instance, um, one of the things we do for breast cancers is we um give out ER and PR results. And so we have special stains or nuclear stains, and we do we we count nuclei and say, okay, you know, that's 80% of these cells are positive for estrogen receptors, and they know the patient can get you know treated or whatnot. Yes. And so um there's AI can sit there and kind of analyze that slide and say, okay, I've counted up all the nuclei, and this is how many of them have this degree of dark staining, and can give you a number, and that might help speed up your day as you know as a pathologist and things like that. Obviously, you've got to go back and confirm those things. We don't necessarily use that in practice currently, but that's something that I've seen out there. It's coming on the horizon, I think this joke. Yes. Absolutely. Um, another thing is just really that I think is even closer in the pipeline for us as pathologists, is just digitizing slides, um, whole slide imaging. So um just taking those slides, much like with a radiology film, uh, we're kind of still in the butt we've got the physical film, we've got the glass slide. And glass slides are super cheap, super cheap to make. Um, they'll probably never go away. But you do have to store them. We do have to store them. That's a physical storage issue, yeah. Yes, um, yes, that's a whole thing in and of itself. Uh but digitizing those slides and putting them on the computer, and then of course you're trying you're trying to store all of that data, high-definition data, into the cloud somewhere. So a whole nother file storage system there. Um but I think that's actually closer on the horizon uh for us than some of the AI getting into our field.
SPEAKER_02Yeah, you know, um th there is some element of the the short-term solutions where AI can help, maybe with dictations and other things like that. That can, you know, you can just say what's going on and not have to press it. That can help with our time. I think that's an aspect. Um counting number of cells, I I think there's probably some aspect of it being able to do that relatively soon. Um will it be able to do the different um stains and interpretation of that?
SPEAKER_00Uh there's a lot of nuance to that stuff, and I just don't see how it's gonna make it there. Uh I'm very skeptical. Okay. Yeah. Well bread and butter cases, maybe. All right. If it's a tubular adenoma, the colon, uh uh uh maybe. Yeah. But um boy, it's w we we're worth our weight in gold on that, you know, five to ten percent of cases that you know are are challenging.
SPEAKER_02That's the old uh 95% of the training is for five percent of the cases. Uh yeah. So that's it. Um so is that kind of leans into the next question, which I I had asked about the near future. What about the far future? What do you think that that really holds for pathology?
SPEAKER_00Um You know we're not a rapidly developing field as far as what we do. I think the molecular testing is is gonna advance us uh quite significantly with these two with you know classifying these tumors as I spoke to before. I think that's really gonna change a lot with how we um classify things. Um I think I think that's really the direction we're going is the molecular testing.
SPEAKER_02Yeah, yeah. I I think the molecular testing um doesn't really lie in it with all the cells that are really that are, you know, the metastatic cells are going to have to be able to have this information imbued in them. And so so being able to test for that I think is really gonna be a lot of things.
SPEAKER_00And there's a lot to it that we don't we don't know what it means when we get some abnormal results back on that stuff. And we're still kind of figuring some of that out. And as we're figuring it out, we're applying it to these different subtypes of tumors and things like that. So um I think that's kind of where we're working towards right now.
SPEAKER_02Yeah, now uh in your mind's eye, how do you think of cancer? Do you think of cancer as uh some series of different diseases? Is it is it really one main physiologic process that that's a whole stars off?
SPEAKER_00No, there's a whole lot of different things that factor into it. Um you know, uh lifestyle, genetics, um diet, I'm just there's a million. Factors, I think, that fact that go that go into it. Everybody's different. We get some patients and you look at their history, their pathology history, you know, and it's three pages long, and you're like, okay, this patient's we call you know this patient's a grower, they're gonna grow stuff. This is what their hobby is. And then others, you know, you're like, well, wow, this one's 92, and this is the first time we've seen this patient.
SPEAKER_02And you know, so it's well it also kind of um that gives a kind of statistical prognostic value. You know, it tends to be if you've got a 30-year-old that's got a breast cancer, that tends to be an aggressive cancer. Correct. It's coming out hot. Yes. If you have a 95-year-old with a breast cancer, you know, it's relatively slow growing. Of course, if they're uh not feeble and they're active, yeah, you would talk about uh treating that potentially. But the there is some idea of how um likely these things are to kill you that you can kind of have a feel for um just from a clinical scenario alone. Aaron Ross Powell Absolutely.
SPEAKER_00Absolutely. And we can look at the cells too, you know, and say, hey, these are very aggressive looking. Yeah, we looking at the high mitotic rates, or they're lymphovascular in the agent and they're not behaving well, you know, and so we can we can we can allude to some of that as well.
SPEAKER_02Yeah, and you know, you had said this earlier, there there's occasionally you get to this is metastatic disease from unknown origin. Correct. It's so undifferentiated. It's such a pluripotential cell there. It doesn't look like anything, it doesn't look like prostate cells, it doesn't look like colon cells.
SPEAKER_00So a lot of it's it, you know, a lot of um tumors they try to recapitulate like where they came from, you know?
SPEAKER_02Or try to behave like colon cells in their line.
SPEAKER_00Exactly, exactly. And so a lot of times they keep a lot of those cell characteristics, you know. Um colon cancer, like you just said, um, they're known for being tall, dark, and dirty. They're they're columnar cells, they're the nuclei are very dark, and they have necrosis with them. And so you see that in the liver, and you you know, you think, okay, that's probably gonna be probably gonna be colon. But a lot of times it can be very poorly differentiated, and that's where some of our markers come into play, you know, with CK7, uh CK20, um, CDX2, these are all special stains that we can use to help differentiate where those tumor cells originated from. But there are, like you say, certain times where they're just so poorly differentiated they've lost all of those markers. And that's a tough phone call to have because you've kind of exhausted and did everything you feel like you can do as a pathologist, and you call up, you have to call up that clinician and say, You got me great tissue. I still can't quite tell you where to look. Or sometimes I have it down to, hey, you need to look at you know, GYN, lung, and maybe like upper GI tract or something. Like these are some places to look. And you can kind of narrow it down for them. But um, yeah, it that's that's a disheartening conversation to have as a pathologist of I can't exactly tell you who it is.
SPEAKER_02The body biology doesn't have to play by our rules.
SPEAKER_00No, and neither do the cancers don't always the ones that read the book are great.
SPEAKER_02The ones that don't are uh It's not really concerned about you getting the diagnosis right, it's concerned about um doing its own thing. Yeah, and it does. Yeah.
SPEAKER_00And one thing just for the listeners, uh I get asked this all the time. People want to know, what I get asked all the time, what color is cancer? Okay. And and I always ask, well, what color do you think it is? And I always say, oh, it's black or it's red, or some sort of evil, you know, some color that's associated with evil, right? And while melanomas, you know, can be black in their art, you know, some vascular tumors that are red and things like that, it's whitish tan, you know. And so I thought for the listeners, I might want to share that little nugget of some of the Well, look, that was that was next year because I was gonna ask for a fun fact about you.
SPEAKER_02Okay, or your organ here. So that's so so that that counts right there. So uh cancer is just mm as banali colored as uh general tissue is. So um now um if you could talk to um pathologists that are just starting off in their career, uh what advice would you give them?
SPEAKER_00Uh learn what normal is. Normal's gonna save you. I've mentioned it before and it just can't be overstated. Learn learn what normal is. Um and trust your gut. If there's any inkling that something might not be right, something's a little fishy, uh, you're not a thousand percent sure in your diagnosis, reach out for help. Um it doesn't matter if you're first day on the job or if you've been doing it for 25 years, um, you'll you'll you'll be surprised. Sometimes I, you know, I g I give a differential for a case that was shown to me, and you know, I th I think maybe I'm throwing something out there that's in the dark, and that might end up being what it is, you know. But um somebody just didn't think of that in their differential or whatnot. And so um yeah.
SPEAKER_02This is this is kind of akin to what we were talking about of you know your your eyes going to the right place, your eyes going to the pathology whenever like you get some some training and some intuition. Your intuition can guide you in a lot of ways. If something just feels weird, pump the brakes. Yeah, do something there, okay? Say it trust that that that is a good feeling. Your body is trying to take care of you there, so so trust that. I like that idea. Um well now tell me what you do for fun.
SPEAKER_00Oh man, um I'm a big outdoorsman. Okay. Um, I like hunting, fishing. Okay. Um I just put in for my gator tags uh yesterday. Yes.
SPEAKER_02Okay.
SPEAKER_00Um pathologist life. All that kind of stuff. No, I had a friend uh one time, and he's like, he's like, you're the uh nerdiest redneck I've ever seen. And I was like, great. Thanks. I look through a microscope all day and then I go and do all that kind of stuff when I'm off. Um like spending time with my wife and kids. Um my kids are big into soccer. I was too when I was younger. Yeah. Um, and so uh yeah, we do a lot of playing soccer in the yard and traveling around to tournaments and things of that nature. That's awesome. That's awesome.
SPEAKER_02So you're getting then so you get to um at work be looking down, hone down over a microscope, and then go be active when you get home. So 100%.
SPEAKER_00And then my wife, uh well, we've got uh a pretty it's a hobby farm, but it's it's quite a bit. Um goats, chickens, you kind of have different hobbies.
SPEAKER_02I just want to be clear about that, okay? Because that's that's you don't have this at your house, no? No, no, no, not yet.
SPEAKER_00No, you don't have bees in your front yard over here. Oh no, you're going to the bees level too. Okay, yeah. So there's always something to be done at my house. I spend a ton of time outside when I get home from work.
SPEAKER_02Yeah. Do does it feel arduous to you or do you love it? Love it. Yeah. So it's just absolutely yeah.
SPEAKER_00It's uh there's very minimal TV or anything else that's watched at my house. We're always outside doing something. Yeah. Um now how old are your kids? Uh seven and eleven. Seven and eleven. Both girls. Awesome. And um super sharp. Um, it's funny watching them. Uh they're like their attitudes that they have uh kind of blends over into their soccer play styles and stuff, you know. That's kind of fun to watch. Uh my oldest daughter's uh very mature for her age and very cerebral and things like that, and that plays into how she plays on the soccer field. Uh my youngest daughter's a real go-getter, kind of a wild card, and you see it on the soccer field, she sticks her nose in the fan, and then she'll do it again just to make sure she didn't like it the first time. And it's so fun uh kind of watching their little personalities play out in other areas of their lives.
SPEAKER_02I had the exact same experience with uh my nine and seven-year-old that uh we were playing soccer outside, and um the nine-year-old is is more pensive and and thoughtful about it. And the seven-year-old, I was dribbling around her, and she absolutely just kicked me in the shin. So it was just like, yeah, yeah, just take it. And I was like, yeah, that's not fair. She didn't care about the rules. Sounds like ours were one of the same. Yeah, exactly. Absolutely. You shouldn't be slide tackling, but here we are. So um uh now um, you know, we often have a um scripts that we go through whenever we're talking because we were often patient forward over in our special days. So, for example, the scripts that I'm gonna talk about if you're gonna have a heart catheterization, it's it's these topics that I start talking about where it's almost like my brain just goes off into it and it's three and a half minutes long and I hit the same cadence and do that kind of thing. I wonder in your world, since you're not necessarily patient-facing, do you have scripts where you start when you're talking to surgeons, do you have this kind of, well, we can't always be 100% sure? Like, are there those things that you talk about?
SPEAKER_00Well, there's certain things, uh, yeah, to a degree. Um, there's certain uh there are comments in our reports a lot of times. I get a metastatic squamous cell carcinoma and a metastatic squamous cell carcinoma from the esophagus, the skin, uh, you know, lung, anus, any anywhere, it's gonna, it's, it's gonna look like a square. It's gonna look like a squamous cell. And so I've got my standard you know comment that I put in there that says, hey, it's a squamous cell, they're gonna look the same, they're gonna stain the same from all these different sites. Yes. You have to look around. That's that's more up to you. Yes. Yeah, it goes, it goes in our comments, but yeah, I can kind of turn my brain off during those moments and it it comes out. And if you look at my reports for that particular comment or other similar ones, like, it's probably gonna be the same word for word. And it's not one that I just copy and paste in there, it's just it's just instilled in my brain for those certain situations.
SPEAKER_02Yeah, this is like uh occasionally I'll have uh you know patients that say, like, uh you told me to check my blood pressure twice a day and something, and I was like, I would never do that ever, ever, ever, ever. Ever in history. I I totally related. I know for a fact, without no remembering this interaction, I know for a fact I would never do that. Yeah, my wife would get a CT in my head if I said something like that. So that's that's not what's happening here. So um all right. Well, um, look, we appreciate you being here. Are you ready for some rapid fire questions?
SPEAKER_00Yeah, I got one for you at the very end.
SPEAKER_02Good, good, good. Yeah, we can do it that way.
SPEAKER_00Okay, and you can include it in the in the next you know a couple podcasts. We might get it. We might.
SPEAKER_02Okay. All right. So well, so you have uh seen the podcast before, so uh maybe you'll be hip to this. Um who's the smartest person in history?
SPEAKER_00Um so I feel like the low-hanging fruit here is Einstein or uh Newton.
SPEAKER_02Yes.
SPEAKER_00Um, but I think um I'm gonna have to go a little off the cuff here. Willis Carrier. Oh. Uh, an American American engineer. Um he developed the modern air conditioner. Uh in I believe it was 1903, 1906, something like that. Don't quote me on it. But just think about where we would be without, I mean, even in here, yes, without modern air conditioning, uh, or ORs, what would that look like? What would my laboratory look like? All those machines with, you know, that we wouldn't be able to run them. Um so um talk about changing things quite significantly. Yeah. And what about an August in in Florida, in Panama City without the sea, right?
SPEAKER_02Yeah, I know. I I would lose my mind, I know for a fact. So um, well, uh you know, uh kind of interesting, and and apropos to Einstein, is he apparently created a refrigerator that had no moving parts. Really? Yeah. Now, um as rumor has it, GE bought out the patent and would never sell it because it was it doesn't have any moving parts. And so I mean, how does one come up with these kind of things? But uh this is just great technology that allows us to be alive now. So good answer on the AC there, okay? Um if we can live to be a thousand years old, should we do it?
SPEAKER_00Um the I mean the correct answer here has got to be yes. Um but I'd want to see what the gross description was for that Model T 1000 human. Um do we look like the 1983 Honda Civic with the hatchback that's a different color than the hood and then the door, you know, where we've replaced all of these parts. And what what happens when we've your mind is eventually going to go? Do what happens when we replace that? Um what's the quality of life look like, you know? Um and that's not even thinking about what the effect of uh of of humans living to a thousand has on the population, the earth, the resources. But I figured if we're if we're able to live to a thousand, we figured the rest of that stuff out already.
SPEAKER_02Yeah, I would hope so. And I would hope that this would, you know, include us being active, uh not not just alive, but alive and doing stuff and and having some meaning, some still some passion in life, right? Yeah, yeah. I think I think that meaning is probably the thing. I found that to be the kind of divining purpose that I utilize for my patients, which is that our job is to get you to where you feel great so that you can add more meaning to your life. This is ultimately what we're here to do. And meaning doesn't necessarily mean living longer, by the way. Right. It just means the things that you're doing that mean something to you. Not to me.
SPEAKER_00Having some joy and some happiness, yes. Absolutely.
SPEAKER_02Increasing joy span. Increased joy span. Okay. There we go. Um now, do you want it too cold or too hot at night?
SPEAKER_00Oh, absolutely, too cold. It's too cold. Um, you can always put more on. You can't take more off. I can't say it enough. Yes. Yes, too cold. Yes. Easy answer.
SPEAKER_02Hard agree. Um, what is one thing you would tell yourself if you could go right back to when you started med school?
SPEAKER_00Um probably a couple different things. One, go ahead and marry my wife then. Don't wait any longer. Yeah, just you just go ahead. Um two, um, imposter syndrome's real. Yes. Um, and I and I think I I didn't necessarily even know I had it until I started kind of reflecting on things. You know, I I always kept waiting for them. Somebody I was just sitting there, somebody's gonna pull me aside one day and be like, hey, hey, hey, they're gonna find me. Hey guy. Well, you shouldn't be here. You don't know. We messed up.
SPEAKER_02How did you get this? Yes.
SPEAKER_00And so um, and obviously that never happened. Um, but you you're you're surrounded by you know what they say is the top one percent uh of the population, you know, uh as far as intellectual abilities and things like that. And you sort of think to yourself, I don't belong with these guys. Guys are super smart. And you're and you don't realize it. You're performing. I mean, you know, you're performing the whole time throughout that, but you always feel like, man, I just don't belong here. Same thing. You come out of I come out and I'm you know, I'm starting pathology and I've got these these pathologists that I'm working with, has been doing it for 25 years, can do it with their eyes closed and on their head, and it's like I'm not that yet.
SPEAKER_02Our decision means the same thing, like we get paid the same amount for that?
SPEAKER_00Yeah, do I belong here?
SPEAKER_02Yeah.
SPEAKER_00Um, and ultimately, you know, you realize it quickly that you know you do, but it's just it's always kind of there in the in the back of your mind. So um, yeah, that would be that would be a you know, you just kind of have to try to get get past that. Um, and then to take every opportunity, my last name would be to take every opportunity that they give you during training. Um, you know, if you're on one of your rotations, you're doing ER, and they say, Hey, would you like to try to run this code when it comes through the door? You know, they're not gonna force you to do it, but you could just you could certainly say no, but you trust in your training. Now's the time and try it. Because you might like it. You know? Um, and I was pretty good about that and cognizant of that. Um, I think I wish I would have been a little more aggressive, actually seeking those opportunities instead of waiting for you know be asked or whatnot.
SPEAKER_03Yes.
SPEAKER_00Um, and so even a stuff I've maybe known I wasn't interested in just to get that experience. Because when I did do those things, I was like, wow, I perform better than I thought I would. My training is kicked in and I do know what I'm doing a little bit, you know. And so um, yeah, I would I wish I would have taken a little bit more of those opportunities. Because at that point in training, you're somebody else's baby. Like, you know, they're not gonna let you fall, they're not gonna let you hurt the patient. Not gonna let you get dangerous. Right. That's that's why you've been entrusted to them. But um, yeah, that's the time to learn and make those mistakes and go through that process. And so, yeah, I would encourage all the medical students to kind of put themselves out there.
SPEAKER_02That's the really great answers, really sage advice. Um, I I do want to uh hone down in on the imposter syndrome just for a little bit because that is that is really something that's sage that you said there. Um it's true, it happens. You belong. Like you you can do this. Um, I I certainly was concerned at every step along the way for the exact same things that you had said there, and then eventually you realize no no no, it's now maybe we all don't belong. Now that's one thing that could be there, but but either way, uh you just keep digging in and and keep trying harder and be humble about yourself, and then you're gonna continue to learn a lot more than you ever thought you could do. So great answers. Um all right. Um what is one current medical treatment or therapy that we are gonna shudder at in 15 years that we used?
SPEAKER_00Hmm. Uh I think some things are gonna change. Gotta talk about some things that are gonna change. Take your time, yeah. Birth certificates are gonna be different. Um, I think I think I think you're gonna get your birth certificate, but I think you're gonna get something, thumb drive, whatever it is, where you're gonna get your we're gonna do some whole genome sequencing. Your DNA. Yeah. And then you're gonna get that, and you and that you're gonna have that, you know, from birth. Um now, obviously there's gonna be de novo mutations and things like that kind of along the way that can change things. But I mean just uh That might actually be formative too.
SPEAKER_02If all of a sudden you see uh these changes have happened over here and that this predisposed you towards some sort of condition, well then you know that that happened spontaneously as opposed to germline or something. So yeah.
SPEAKER_00Yeah. Yeah. But um, yeah, let you know what disease processes you might be predisposed to. Do you metabolize certain drugs appropriately as well as others? Are there certain antibiotics maybe you shouldn't take? Um all kinds of things.
SPEAKER_02This is the human pharmacome project writ large. And then at some point I I think we get the epigenomic idea of we can make we can utilize even uh intronic DNA, uh DNA that's not usually coded for protein, and we can utilize that and make our make brand new proteins that can do things. We can we can make red blood cells that have their hemoglobin that's better affinity for oxygen or something along those lines. You know, I I think that that that's a project that comes along too at some point. So um yeah, birth certificates. That's one I didn't expect here. That's a good bingo card there. Okay, all right. Um how about what is the best song of all time?
SPEAKER_00Uh um I'm a country fan, so I'm gonna say some Charlie Daniels to went down to Georgia. All right, that's a great one. Yeah, that's a good thing. I know.
SPEAKER_02Everybody knows it, everybody loves it. I mean, so so it's uh it's a crowd pleaser. Um tell me what books you read.
SPEAKER_00Um so I don't do a lot of reading for pleasure at all. All right. Uh never had working on the farm for that. Exactly. That's the majority of my evenings and where a lot of my free time goes. Uh never have been a big reader. Uh, wasn't necessarily I mean, you know, obviously you've got to read for medical school, and I read my journals and things like that, and I'll stay up to date on literature and current practices and all that. But as far as reading for fun, um it's just not my thing. I'm rather be out there doing stuff, working with my hands, things like that. Um interesting story about reading. I uh uh first week of medical school, I come in and uh they teach us they got a guy that comes in and for the first week we're learning about how to speed read. Oh they think we need to do speed reading for medical school, right? And so you should have seen it, Don. There were people uh that were um dropping out um in that first week because they say, oh no, like I have to be able to speed read to get through medical school. This is crazy. I can't, there's no way I can handle this. No. So people were dropping out, and uh, you know, I attempted it and was not very good at it. Yeah, it's it's kind of a learned thing. And they made some statements, oh, you'll retain 60 and up to 70% of what you speed read and things like that. But um, my favorite part, and uh guy ended up being the best man at my wedding, but I didn't know him, I didn't know him at the time from Adam. And he sat next to me, and we're in this big auditorium. There's you know 140, 160 students in there, and uh he gets on, we got these microphones, you push the button, and your voice goes out over the whole auditorium. It's the last day, and the guy asks if anybody has any questions, and my my buddy gets on there and he goes, Hey, he says, Um, what do we do when we get to a word we don't know? And of course the guy said, Will you stop and look it up, you know, and look up the definition? Of course, my buddy got back on there and he says, I don't mean to be disrespectful, sir, but this is the first time I've ever been to medical school, and there's gonna be a lot of words I don't know. And I immediately went, I like this guy. This guy's alright, me and him. Me and him are gonna get along just fine. And so uh yeah, I remember that day. But um, no, the speed reading did not stick with me. No, it did not stick. It was not a talent that's fortunately.
SPEAKER_02I'm not sure. Yeah, there's a buddy of mine who uh uh can speed read, and he talks about it, and I'm like, eh, no, it just doesn't land on me. So well, you do do you listen to any other podcasts or anything else that you find time for?
SPEAKER_00My wife makes money, but I do a little FSU sports podcast. Yeah, you're a school sporting guy. Um but uh no, that's pretty that's pretty much it. No, not a lot of not a lot of podcasts. I do some music and stuff like that.
SPEAKER_02Butcha, gotcha. Well, we'll have to have you out to the soccer field on my uh soccer team. We're playing the league right here. Yes, so you can talk about that offline.
SPEAKER_00I used to do that when I was still you know going to school and stuff. Yeah, I was known that, so that's great.
SPEAKER_02I'm just waiting for the ACL to tear. That's really all I'm doing it for. Okay, so all right. Uh now I've got one question for you.
SPEAKER_00Uh I like I like asking other clinicians this. I think responses tell a lot about them. But if you couldn't do medicine, you had to go back and do something else. Yes. What do you think you would have liked to have done or what would you have ended up doing?
SPEAKER_02My dream going into college was to be an architect, but um I had the math, I didn't have the art. Um, I would love if somehow uh that could be if I could design buildings or something along those lines, that would be great. Um my my family was, I mean, it's kind of tongue-in-cheek, but uh they were kind of disappointed I wanted to go into medicine. They thought, you'd be a good engineer. Okay, yeah. So anyway, um, but either way, uh, so I would think something about that. Uh if if I could find the artistry and doing uh architecture, I I would be the kid and me designing bridges or buildings would love it. Yeah, yeah. But I just wanted the talent for it. So that's all it's a good answer. All right, no, it's hey, look, I love this idea. We may be incorporating this into our new rapid fire, okay? Yeah, so we'll give you some uh some coinage for that, okay? Um Scott Taylor, uh, where can the folks here get in touch with you and your group?
SPEAKER_00Oh, sure. Um so uh KWB Pathology Associates, um, we're in Tallahassee. We've also got an office over here in Panama City. Um you can email me um at staylor at KWB Pathology.com. Um you can also call the office, ask to speak to me anytime, or just swing by. We'd love to give you a tour or anything like that, really. We like visitors pathologists. We don't get a lot of visitors.
SPEAKER_02I know, so we learn when we get visitors to people interaction. You don't hiss whenever the door opens or anything like that. So um uh well, awesome. Uh we'll have some connection information here um in our show notes here. Um so thank you so much for being in our community. Thank you for um doing the things and making physicians better um at the job that we do and trying to take care of patients. Um thanks for being so knowledgeable and personable, and um thank you for helping us make medicine better together. Appreciate it. Thank you.