The idea that pathology relegates specialists to a dim basement lab in solitude, waiting passively for specimens to appear, is a common one. But this stereotype does not reflect what today's pathologists actually do, according to breast pathologist Nicole Dawson, MD, who proudly points to her sunlit eighth-floor office at UCLA Medical Center, Santa Monica: "We're nowhere near the basement," she says.
Dr. Dawson initially shared in the widespread misconception of life as a pathologist. For her first two years of medical school, she considered a career in primary care. That changed when, following her third-year rotations, she was offered a year-long student fellowship in pathology. "The discipline's appeal is being able to apply all the basic science knowledge learned during the first two years of medical school," says Dr. Dawson, who, after returning to medical school, found her initial attraction to primary care become a springboard to a more genuine commitment to pathology.
A focus on breast care
Today, Dr. Dawson, who received her medical training at the David Geffen School of Medicine at UCLA, heads the pathology team at the UCLA Breast Center Santa Monica.
On a typical day, Dr. Dawson works from 8 am to 6 pm, hours when she's on call for the operating rooms at UCLA Medical Center, Santa Monica. When she receives a page from a surgeon, she attends the operating room to discuss the case at hand. "I just had a spinal cord tumor case for which the surgeon needed an intraoperative pathology evaluation," she recalls. "I walked a piece of the tumor back to the lab, processed it and made the diagnosis. That frozen section evaluation guided how extensive the remaining surgery needed to be."
Additionally, radiologists call for assistance throughout the day. "I help guide treatment by evaluating the cells shed by a tissue sample," she says. "I clarify whether they indicate the presence of an infection or a tumor so the radiologist can determine what to do next."
An important part of the team
Breast cancer care now occupies much of her time. As a breast pathologist, Dr. Dawson covers the hospital's clinic for newly diagnosed breast cancer patients, which means reviewing all the pathology before the team meets each new patient. She also participates in weekly meetings of the Breast Center's Tumor Board.
Dr. Dawson ultimately believes her ability to juggle such diverse responsibilities throughout the hospital a tremendous complement in the Breast Center's use of the integrated practice model, in which a patient navigator coordinates each patient's care and schedules all needed specialists in one visit. "This is wonderful for the patients and good for us as a team," she says. "Working very closely with our colleagues increases satisfaction for all of us and encourages collaboration and learning from [one another]."
Science at its best
Between pages, calls and consults, Dr. Dawson reviews specimens and completes reports on exams just like the intraoperative frozen sections and radiology cytology slides she worked with recently. Of course, with a breast specimen in its gross state consisting of 100 or more slides per case, this report writing time adds up. Dr. Dawson also incorporates research and teaching into her schedule, and always makes time to be a preceptor in the hopes of getting more medical students excited about pathology.
"I always recommend an elective rotation because pathology is not a required rotation. If you don't seek it out, you won't get exposed. At the very least, do some shadowing with a pathologist," she says. "People are always amazed when they see the diversity of what pathologists do — not just students, but my colleagues — they've learned a lot about pathology, too."
By Darcy Lewis