A philosophy of practice of surgical pathology: Dermatopathology as model
2000; Elsevier BV; Volume: 42; Issue: 4 Linguagem: Inglês
10.1016/s0190-9622(00)90200-7
ISSN1097-6787
Autores Tópico(s)Medicine and Dermatology Studies History
ResumoA philosophy of practice of surgical pathology: Dermatopathology as model A. Bernard Ackerman, Philadelphia, 1999, Ardor Scribendi, Ltd. 470 pages. $95.00 plus $5 shipping and handling. How one feels about this book depends on how seriously one still pursues the practice of medicine. For those physicians for whom there remains a glimmer of hope that medicine will remain an honorable profession, who continue to strive for excellence in their practice, and who would like a glimpse into the inner thoughts and philosophy that have motivated A. Bernard Ackerman, a Master in dermatopathology and dermatology, A Philosophy of Practice of Surgical Pathology: Dermatopathology As Model will be a welcome addition to their library. From the outset of this review, I must admit that I am biased about Ackerman as he has been, and remains, my mentor. Nonetheless, who better to judge the validity and sincerity of what he has written than someone who has been afforded the opportunity (albeit more than 20 years ago) to have sat by his side at his multiheaded microscope as his dermatopathology fellow for more than 1 year and to have heard his words of wisdom interspersed between cases at all hours of the night and day? Does he really apply all that he has written to his daily activities? I am able to state with authority and experience that what is written in this text honestly reflects the code by which Bernie lives his professional and personal life. Kudos to him for now sharing it with all of us! And as would be expected from Ackerman, the information is presented in an elegant form, from the quality of the paper, binding, print and cover to the humorous and informative illustrations and drawings. Essentially, Ackerman has reviewed his viewpoint about values that transcend the practice of dermatopathology. This is a “treatise about the intrinsic character and quality of the practice of pathology,” a “system of ideas, concepts, and principles formed to enable and motivate the…conduct of that practice for the purpose of achieving…accurate diagnosis.” We are given insight into why dermatopathology was his career choice; the joy he feels for the subject which he views as “art in vivo”; his love of collegiality, fair play, tenacity, collaboration, and teaching the skill of critical analysis; and his receptivity to new ideas, observations, concepts, and critical thinking. In contrast, he shares with the reader his intolerance to prejudgments, bias, parochialism, cronyism, redundancies, flawed terms, anthropomorphisms, “intellectual flaccidity,” poor etiquette vis-a-vis conduct among presumed colleagues, and the last decade’s conversion of medicine, the “quintessential profession,” into a trade or business. Each chapter in the book begins with a relevant quote from literature, philosophy, or science. Forty-three chapters then review Ackerman’s approach to and perspective on medicine and pathology, substantiated and illuminated by examples within dermatopathology. Vignettes from childhood and high school, medical school, residency, and fellowship are warmly recounted, demonstrating affection for his parents, teachers, and classmates. What fun to revisit with Bernie his youth and pivotal experiences. Those of us who double as parents and doctors can gain valuable insight into teaching a love of both learning and reading to our children. The chapters conclude with quotes from previous Ackerman publications emphasizing and enforcing the theme of each particular section. Reiteration of all the lessons evoked is not possible. Therefore, in David Letterman style, the top 10 lessons to be learned from Ackerman’s latest text include: •10. Medicine and pathology should be approached from a historical perspective. Read what was written first and learned subsequently.•9. The pathologist must think like a clinician and the clinician like a pathologist. To avoid mediocrity, one cannot be ignorant of the other’s principles. The pathologist should subsequently couch the diagnosis in terms or language that the clinician can comprehend and that will promote the patient’s best interest.•8. Disease is dynamic; lesions appear differently at different times of evolution. In addition, the expression of the disease process will vary depending on anatomic site, pace of the process, immunologic status, age of the host, and factors not yet understood.•7. Criteria for diagnosis include the fewest denominators without which that precise diagnosis cannot be reached. Hematoxylin-eosin stain remains the standard and the “very best special stain”; “when it does not permit diagnosis to be made with specificity, usually nothing else will either.”•6. Diagnosis is best achieved and the possibilities of error minimized through a methodical approach to a slide by a checklist of consequential steps (algorithmic method) utilizing pattern analysis.•5. A mistake is not necessarily malpractice. “Every morphologist errs from time to time both in making observations accurately and in interpreting observations.…What morphologists do is 100% subjective.”•4. Recognize when you are uncertain and be willing to admit “I don’t know.”•3. Precision in language and concepts is mandatory.•2. The pathologist or clinician is a morphologist. Start your view from scanning magnification without bias of history. As reminded by Arkadi Rywlin, “One looks with one’s eyes but sees with one’s brain.”•1. Keep an open mind; remain receptive to new ideas and concepts. Critical thinking, the capability for analytical, logical, and incisive thinking, is the most crucial component to the Ackerman philosophy of practice. Although I do not want to reveal the ending of the story, the last chapter, “Farewell,” surprised and saddened me. After authoring more than 500 articles, over 30 book chapters, and more than 35 books; after delivering more than 1000 lectures throughout the world; after founding two journals dedicated to dermatopathology; and after founding the International Society of Dermatopathology, as well as other achievements, Dr A. Bernard Ackerman has chosen to spend more time exploring his creativity in other arenas. Although he will actively continue to pursue dermatopathology at his new Institute, he will now also dedicate more time to his newly formed medical publishing house (Ardor Scribendi) and the cultural opportunities in New York City. In conclusion, this serious philosophical text, the world according to Ackerman, is peppered with wonderful personal anecdotes, playful illustrative drawings, and educational examples from the world of dermatopathology. In my opinion, dermatology and pathology residency directors and dermatopathology fellowship directors would do well to strongly consider requiring this as mandatory reading for their students! 16/8/103808
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