[Histonet] Re: Floaters

RSRICHMOND <@t> aol.com RSRICHMOND <@t> aol.com
Tue Dec 12 11:17:29 CST 2006

In my previous post on floaters I think I stepped into a problem pathologists 
commonly handle wrong.

In an ordinary morning's sign-out, I'll usually encounter a case or two where 
the slide's horrible, the diagnosis is obvious, and on to the next case. When 
I do this, I think I'm being part of the solution, but actually I'm part of 
the problem.

If I may invoke the sacred name of Edwards Deming - Deming emphasized the 
importance of identifying and addressing small problems before they turn into big 
problems. If the hematoxylin's a little on the light side today and it isn't 
changed, the slides may be unreadable tomorrow. That placental villus in the 
middle of a gastric biopsy - so obvious it may not even rise to my 
consciousness - may be a floating chunk of squamous carcinoma in the middle of a benign 
laryngeal biopsy tomorrow.

If a junior pathologist complains about an issue of quality or safety, he'll 
probably get chewed out by the boss for his efforts. I suppose that 
histotechnologists have the same problem. Shooting the bearer of bad news is a tried and 
true management technique, probably taught in M.B.A. school right along with 
Corporate Looting 101 and Advanced Necktie Wearing 203. 

Using multiple sets of dissecting instruments with the just-used ones soaking 
in water and washed off every few cases would be a technique worth trying, 
but I've been ignored when I've brought it up.

As for compost, Kemlo, I have quite a large batch of it awaiting my garden 
next spring. I want to try an Indore heap, but my wife doesn't want it in the 
living room.

Bob Richmond
Samurai Pathologist
Knoxville TN

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