Biopsy crazed lot or litigation cowered profession lacking in diagnostic capabilities of yesteryear.
I am from the era where ignorance was frowned upon. Professors walked with a swag born out of years of knowledge transfer most of our present histology diagnosticians could hardly dream of, bundled together in a heap.
Is it an appendix, wait, get the CT scan report first. Lipoma, fibroadenoma, tuberuos sclerosis or neurofibromatosis, wait for the biopsy results expected next week. Extra dural, middle cérébral artery bleed with sub arachnoid extension, don't know, we are waiting the MRI report. The imaging was done yesterday.
Invading the laboratory with fibroadenoma from teens can hardly be justified, not in the first world, not here, don't know what world, not in Ethiopia either. We're sacrificing scarce resources only justifiable for pathology with junk. It could save the DNA lab time for rape cases with multiple downline positives for centuries to come if professionals manned up.
No fibroadenoma mutates into cancer. Granted probability and Bell curve can't reach 100% certainty. As long as a doctor or nurse can diagnose the condition as a fibroadenoma, make the client aware of the negligible to zero risk, and agree to observe, we move on to the basal cell carcinoma that does need a biopsy.
There could be a positive ankle to this though. My last appearance before the principals office was because a nurse that came to me for consultation took an offense to my honest and truthful conclusion. After about 5 minutes swimming through fat around her epigastric area, we found the culprit, a lipoma hidden in the mass of friendlier less globular company. I dared to ask what that specific globule did to her to deserve excisional biopsy.
Why the discrimination? She is a rolling fat bulb as a unit. Shouldn't we take biopsy of her total mass and brave and hyperkalemic complications head on? Needless to say I was given written notice for refusing to lie.
Primary health care can only work as a screen if tertiary level gets the swag and stop being biopsy dependent. The resources are under strain because we biopsy fibroadenomas. We scan the appendix and subdural as equals on the investigative list. The diffential has been driven right up to Google list of every possible option. We might as well have computer send people for scan and save on manpower. Let the security at the gate enter your symptoms on the mainframe. Will save time waiting for the doctor at the very least.
The pathologist and or radiologist cannot and should probably not be made to screen. He saw no patient. The vicious cycle doesn't end here either. Their differential from radiology and histopath doesn't help nobody either. It's getting longer probably as a side effect of vague and direction from the requests too. Could be just fatigue setting in.
We need a Saul moment here. We need divine intervention.
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