Pathology practice in Canada

In their recent editorial, Kathy Chorneyko and Jagdish Butany made several excellent points about the challenges pathologists face, including human- resource shortages and the need for provincial governments to support quality-assurance efforts.1 Their final recommendation was that a national body be created to oversee quality assurance and set national standards, among other roles. This recommendation, although worthy of consideration, is of uncertain value given the fact that several provincial and other groups already fulfill the roles that the editorialists proposed for their new national body.

Two critical aspects of pathology practice were not discussed in the editorial. First, clinical pathology was not mentioned. Medical biochemists, hematopathologists, medical microbiologists, molecular pathologists, cytogeneticists and other specialists in clinical pathology play vital roles in Canadian medicine. Discussions about human resources in pathology often focus on the practice of anatomic pathology; a broader view would be beneficial.

Second, and more importantly, the editorial did not address the greatest challenge affecting pathologists in Canada: the tendency by provincial governments and health administrators to view hospital-based pathology laboratories as cost centres rather than patient-care centres.2 Laboratory resources, both human and financial, have been reduced again and again, following the recommendations of consultants obsessed with centralization and automation. Sadly, this continual paring of laboratory budgets often leads directly to poorer quality care for Canadians, including misdiagnoses, miscommunications, medical errors, longer turnaround times for results and inappropriate therapies.

Canadians may well benefit from “an appropriately resourced national body to promote excellence in the practice of laboratory medicine,” as the editorialists suggested. However, without appropriately resourced laboratories, such a body would be nothing more than a well-dressed shell.