Since we last published a Resident Spotlight feature, the world sure has changed. This interview was conducted prior to the spread of COVID-19 in Canada, and touches briefly on risk communication in the wake of it—a topic that was being discussed as back as early February. We interviewed Dr. Michael Multan, a PGY-2 in Pathology on the topics of his field of choice and the connection that exists between pathology and writing.
Happy reading, and we hope you are all staying safe and well!
You are a Pathology resident, a specialty which doesn’t see patients but makes diagnoses important for patient management. In the field of medicine where so many specialities focus on treating and interacting with the general public, what made you decide to go into Pathology?
The patient is central to all fields of medicine. The way different specialists contribute to patient care can be vastly different. In pathology we work closely with surgeons, oncologists, radiologists, and other pathologists to answer complex diagnostic questions.
As a medical student I learned very quickly that while I did enjoy working directly with patients, I found a lot of the day to day work of clinical work exhausting. Systemic challenges in our health care system (i.e. homelessness, limited resources) contribute to the fact that a large part of most physician’s day-to-day work centers around discharge planning and helping patients navigate a complicated system. I have a great deal of respect for my clinical colleagues and think that there is a lot to be learned and gained from working directly with patients and hearing their stories.
I figured out that I was more interested in focusing my energy on diagnosis. Pathologists still get to work with many people in a typical workday, but the focus of what we do focuses more on the “medical expert” part of medicine. Occasionally, patients will want to speak to their pathologist regarding what was said in the pathology report. In an autopsy setting, we communicate directly with families with regards to our findings around an individual’s cause of death. Communication is still a huge part of pathology but it just happens to be less patient facing.
You’ve mentioned that your specific interest is in Forensic Pathology, due to the interplay between law and medicine. Was it an interest cultivated in your childhood, medical school, or residency? Was there an experience that made you realize this was where your passion lay?
Forensic pathology is a sub-speciality of pathology with a focus on determining cause of death through performing autopsies and reviewing an individual’s medical record. I have always found anatomy and physiology fascinating. In fact, as a medical student I really enjoyed many of my surgical rotations.
The practice of autopsy has many parallels to surgery – it is anatomy based, tactile, and visual. The main difference is that you have a lot more time in an autopsy setting, for obvious reasons. The slower pace and the parallels between surgery have drawn my interests to this field.
A memorable experience that solidified forensic pathology as a major interest for me was the opportunity to attend the scene of a plane crash as a medical student. When I got to the scene with the medical examiner assigned to the case, we were there to take photos and document the scene itself to help in the interpretation of the samples collected. The medical examiner asked me a question I don’t think I will ever forget. “What is your approach to a death scene? The same way you need to have an approach to assessing a patient with chest pain, you have to have an approach to systematically assessing a scene”. This very simple wisdom helped me appreciate the complexity of the field, but also how similar it really was to many other fields of medicine.
You have written two op-eds that have been recently published (as of this publication, that number has grown: 1, 2, 3) on the importance of bettering Canada’s death investigation system, and risk communication in the wake of 2019-nCoV. What inspired you to write op-eds for the public on these topics—or writing in general?
While pathologists don’t usually directly communicate with patients, the ability to communicate complex medical information in a way that is easily understood, specific, actionable, and precise is of utmost importance. The information in a pathology report can be the deciding factor with regards to whether a patient needs additional surgery, chemotherapy, and what their prognosis is.
As a resident I want to work on my writing skills. I think that being able to communicate complex information in a simple and precise way will be very important in my career in pathology. Editorials are a great way to have a voice, raise an opinion, and practice your writing skills.
What sort of connection exists for you between your work as a pathologist, and the writing that you do?
Behind every case there is a patient story.
In forensic pathology there is a huge element of written communication. Once an autopsy is completed, it is virtually impossible to go back and gather more information. For this reason, it is important for us as trainees to learn to write autopsy reports that are comprehensive, easy to understand, and accurate. This is true in all fields of pathology and medicine. The details of an autopsy report could be of interest to the legal system, often many years later. I think that writing is important in all fields of medicine and it is a skill I am actively trying to work on. I’m lucky in that I have found that I actually enjoy writing!
You can connect with Dr. Michael Multan on Twitter.
We are always looking for more residents to spotlight. If you are interested in participating, or know of someone who you believe would be a good fit, send an email to firstname.lastname@example.org.