Dr Kavitha Pai, Trainee Histopathologist
Histopathology is the largest of the pathology specialties. We talked to trainee Dr Kavitha Pai to find out what makes it a rewarding specialty to work in and about what the training is like.
Tell us a bit about yourself...
My name is Kavitha and I’m currently in my second year (ST2) of training in histopathology. At the moment I’m on a seven-week rotation in Birmingham before I move to Wolverhampton for the rest of my ST2 training. My current rotation is jam-packed – I’m doing molecular and neuropathology and I’ll be moving on to paediatric and perinatal pathology. The consultants have been great in helping me settle in quickly, which is important for such a short and intensive rotation.
What was the route you took into histopathology?
I moved here from India three years ago. I had started my training there but wanted to do more in the UK as I wanted to train and work in the NHS. When I got here, I worked for a few weeks in a histopathology department as a taster and the consultants were really supportive. They helped to prepare me for the training interview and made sure I had all the experience I needed to help me secure a training place. In this time I did an audit – a project that evaluates the running of a department – where I assessed how quickly a histopathology report could be put together for a clinical meeting, evaluating each step starting from the moment the specimen reaches the lab till the report is finalised.
What do you enjoy most about your job/training?
It’s a very scientific subject. You get to be the Sherlock Holmes of medicine. You are the person who is investigating everything – why did this happen? Why did this person die… what was the cause of that? You are constantly questioning. It’s the ultimate quest for truth.
And talk us through your typical day at work...
As a trainee my schedule and work timings are slightly different from a consultant’s. My day starts at nine. It’s so varied and different so there are no dull moments – I often find the day passes me by and suddenly it’s five and time to go home!
I start the day by cutting up and trimming surgical specimens such as colon, breast and lung that have been sent in from different departments. This generally takes up the first two hours. Then I’ll catch up with the team over a coffee break – we have an amazing team spirit, something that I think is very distinct in pathology.
Then it’s back to reporting – reviewing specimens under a microscope – which I do independently and then check with my consultant. I try to go to at least one multidisciplinary team meeting with my consultant and other teams where we try and solve particularly hard or unusual cases together, across the departments. Occasionally we have trainee teaching and quiz sessions, where we review interesting cases under a microscope with all our consultants and receive feedback on our report writing and diagnosis.
As part of our training we do pathological autopsies, which involve examining a human body to find the cause of death. I have done 20 such autopsies over the past year under supervision.
And I also have some teaching responsibilities – occasionally I get to teach first and second year medical students, which is a refreshing break from the lab.
Do you have a favourite fact relating to histopathology?
Whilst I was a medical student I heard how a pathologist correctly diagnosed lymphoma in a young man who was being treated as pulmonary tuberculosis without success. The patient went on to have correct treatment and in spite of diagnosing a more serious condition, the patient and his family was thankful that the right diagnosis was made and he received an appropriate treatment. There were couple of similar cases which left a lasting impression on me about a pathologist’s role in patient management.
Are there any particular challenges that you face?
Because histopathology plays such an integral part in understanding disease, many people rely on the reports we produce. This means it’s quite time-sensitive work and time management is the biggest challenge. Sometimes if we don’t find the answer straight away we might need to do more tests, but we need to make sure that delay is communicated to the clinician and final results are delivered as soon as possible. It’s a bit of a race against time.
What thing are you most proud of in your career so far?
I am absolutely proud to be a part of the NHS, especially as it turns 70. Every day I know that I am making a difference to patients’ lives. Even though I am lab-based and don’t see the patients myself, I know that my reports are vital in managing and treating both simple and serious diseases. Meetings with my clinical colleagues are vital and it’s always nice to hear how a patient is doing.
What advice would you give to new trainees?
Any training programme is quite intense, so be prepared for something demanding. I’ve worked in different specialties before pathology and I’ve never seen consultants who go so far out of their way to help their colleagues as pathologists do. Everything about pathology training is new and different, so be engaged and take an interest.
How do you balance work life, social life and formal learning (revision and preparing for assessments)?
One of the advantages of my job is that it’s quite flexible in terms of my working hours – I can start and finish early as long as I get my work done. I don’t normally work after five or at the weekend, which makes it easier to balance my social life and find time for reading and studying. There are no on-calls and I can take things at my own pace, which would be harder to do if I worked on the hospital wards.
Digital pathology is making it easier to work from home, too. A consultant from a distant hospital could send you a slide and you could comment on them instantly. Some hospitals have started this already – it’s a brilliant initiative and, as I see it, the future of pathology.