[Histonet] Number of Blocks Submitted by PA

[Stephen Peters M.D.]

There are a number of excellent references such as the Manual of Surgical Pathology 
by Susan Lester MD or the index of Rosai's Surgical pathology which offer 
recommendations on number of sections to be sampled in the common specimens. 
Depending on the gross findings a pathologist will take additional sections as he sees 
fit depending on the gross. There are many cases that do not fall into these typical cases 
and the pathologist or PA will section them as based on their impression of the case.
 When the pathologist is grossing a case he often has a good idea of what he will need  
for sections and can be conservative if that is his nature. It is more difficult for the PA
 to second guess the pathologist so when the PA is unsure how much the pathologist will 
want they tend to put a bit more through initially so they do not have to go back a second
 time leading to more work and a delay of the case. The number of blocks will often 
be inversly proportional to their level of experience of both the PA and the pathologist. 
 
A point I try to stress with my group is that even though they may think putting through
 " more than necessary " may seem like an innocuous practice, in fact overloading the 
histology staff will stress the staff and  can lead to potential mistakes as well as a 
delay in the work. This  will effect the entire department.  The same logic applies to ordering
 of specials and immunos by the less experienced pathologists. If you recognize a trend 
of increase work coming from a indevidual PA, or pathologist it may be worth discussing it 
with the medical director to see if their is valid reason to further educate these indeviduals.
 
Stephen