Of lab-dwellers and good-hair days... Pathology: It’s medicine, Jim, but not as we know it

The first thing that struck me was the hair. There was just so much of it and, from where I stood, very little was grey.

Is pathology the specialty where the cool kids hang out? After attending a fair few GP conferences and events where my more salt than pepper barnet seems to fit right in, I was keen to find out.

But, with all due respect to these brainiac lab-dwellers, my failed attempts at casual conversation suggest there is a reason these practitioners spend so much time peering down microscopes far from the nearest patient. Not big talkers.

No matter, I’m at Pathology Update 2023 in the frankly cavernous Melbourne Convention Centre, courtesy of my lovely hosts the Royal College of Pathologists of Australasia – it seems only fair to give them an early name check. Sorry, I know I kept calling you RACP.

It’s the tribe’s second post-lockdown gathering, with 1300 attendees in, well, attendance. And at times it felt very familiar, what with the repeated refrains of overworked and understaffed with a weather eye on the emerging AI systems, which set plenty of my bells clanging.

Not that I could hear them much of the time. For two days we shared a common wall with some wide boys who apparently use Miami Vice reruns for fashion advice and women rocking that look popular among staff working the counter at discount make-up salons.

Our first plenary session on Saturday morning was enhanced by next door’s thumping bass beats, actual screaming and the stomping of feet. Thinking it was a cult, I approached a woman standing guard at the door: “What’s all this about?”

“Well, I’ve been told it’s not a pyramid scheme, it’s more a triangular business model.”

That makes even less sense written down, so I ask again: “Oh,” she says, “it’s Amway.”

Enough said...running away now.

As with all such events, you quickly slip into the routine of zipping from room to room checking out whatever subject tickles your fancy, and I was keen to experience the full spectrum of pathology. Minus the forensic stuff, no media allowed and fair enough, there are things I don’t need to know or see.

Which brings me to monkeypox. This had to be interesting and, sure enough, our host bantered on about how this lurgy made its way to Oz. They of course discussed the various symptoms and impacts, including lesions which can arise in places where lesions have no right to be, “and I’ve got some slides to show you later”.

Hell no, you don’t. Oh, hell yes, he does, and being a humble reporter, I never wish to see such images ever again. Ever. A pox on the pox.

Now, obviously I’m no expert, but after three days of such revelry, I concluded that pathology is a bit odd, while GP CME needs to lift its game on the sweets front.

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One of the presentations I sat through looked at new categories of teeny tiny growths. It had been thought all strains of this particular greeble had been thoroughly looked at by now, but no, tons more have popped up, with each urgently requiring a name, a description and inclusion in the Big Boys’ and Girls’ “Book of Teeny Tiny Growths”.

I sat through several such talks and, hopefully no offence, but I was struck by how pathology often seems an end in itself. You find a thing, you describe the thing, then you name it and move on. It’s biological cartography with a side of colouring-in. Pathologists love dye almost as much as hippies do.

I would have liked to hear the occasional “why” question asked.

Yes, I get that flu rates flatlined when COVID-19 was running rampant, but why?

I did, though, enjoy the puzzles. The “here’s a smear on a glass slide, now tell me what it is” stories.

This I can get my head around, but to join in I’d need more information, such as the number of syllables and whether we’re talking movie, song or show. Otherwise, I’m lost.

But the thing I really missed from general practice conferences is the back and forth. There was scant time for questions or challenges, with every precious second filled with as many words, numbers and nasty images as possible, and not all of them were comprehensible – I note here that the best speaker over the three days was a former GP. Practice matters.

There was also no political or medical establishment presence, so no ministers to harangue, no director-general types to glad-hand and, while pathology has serious equity concerns – one slide showed two-thirds of the world’s histopathologists work in only 10 countries – being an almost entirely in-house event, the alert had nowhere to go.

Links were also made between the rise of AI and a survey of Australian facilities that found only 3 per cent were adequately staffed to meet demand. When your job is this prescriptive – one speaker noted pathology has been around for hundreds of years and shows no signs of changing – you’re a sitting duck for automation. Especially when the vulture watching from the trees has a digital brain capable of exponential learning.

I asked a few people if they felt threatened and the general vibe was sure, Skynet is coming, but no worries, it’ll just take over the grunt work so we humans can concern ourselves with loftier tasks.

Speaking as a journo with one technology-assisted redundancy under my belt to date, good luck with that.

Sadly, I expect many of those lovely heads of hair will have turned grey when next the tribe gathers.