Pathognomonic
It is recognizing when the pattern fits — and when it doesn’t.
The third in a series of excerpts from our interview with pathologist Dr. Eve Crane. Here, Dr. Crane talks about the role pattern recognition plays in pathology and whether those skills in innate to an individual or can be taught.
The WorkNotWork Show 0:30:41 You’ve referred to cases as puzzles that must be solved and identifying a pattern is critical to that process. Are these seemingly ephemeral pattern recognition skills innate to a particular individual like yourself, or can they be taught?
Dr. Eve Crane 0:30:58 Yes, I think this is great question, because this gets to what a pathologist is.
There are some patterns. You look up in the sky, you see a rainbow and that’s a rainbow. Everyone’s going to recognize that. And there’s quite a few entities in pathology that look a particular way. A certain mutation happens, regardless of the patient, you get that same pattern forming.
And by the time you’re done with your residency training, you want to have those in your mind, so that when you see that, you’ve got it. And we have even a particular word for that — pathognomonic.
WNW 0:31:37 Explain that in terms that our listeners will understand.
EC 0:31:41 If you have a particular constellation of symptoms, for example, somebody with infectious mono — I have a 20 year old college student that has swollen lymph nodes and a fever, and he has a swollen spleen. That whole picture’s pathognomonic for that.
So there are certain entities like that…usually you see a pattern and particularly how the cells are arranged, what kind of cell types are there, how the cells look, there are certain patterns. It’s not rocket science. Anyone studying it can see those patterns.
Where pathology gets fun, is when it doesn’t quite fit the pattern. It doesn’t quite maybe fit any pattern.
WNW 0:32:25 There must be situations where it is close to mono, but it’s not mono?
EC 0:32:31 Yes and actually there’s another virus, Cytomegalovirus, that causes the syndrome that’s close to mono but it’s not mono. It’s a different virus. You want to be trained to the point where you’re not going to miss these ones.
Most diagnoses are not something completely strange and completely unheard of — the flu is the flu. People get colon cancer — it’s colon cancer. But you want to know when am I seeing something that’s not right? What is something really different, what is something showing up that we never have seen before?
When we started seeing these brain lymphomas, it’s — wait a minute — clinicians said they haven’t even seen a patient like this in 15 years, and we just had five. That’s not a pattern that we normally see.
You don’t want every case to be totally weird otherwise you never get anything done. But, you have this combination of unusual cases. and there’s a lot of common diseases that will present in a very unusual way.
There is so much more — please listen to this excerpt by clicking any of the timecodes above, or listen to the entire interview. We welcome your comments below as well as a clap or two if you feel so inclined. Also, ratings and reviews on Apple Podcasts are invaluable and very much appreciated. Thank you so much for listening.
