Common Elements of INTERVENTIONAL PATHOLOGIST ® Procedures

“But words are things, and a small drop of ink,
Falling, like dew, upon a thought produces
That which makes thousands, perhaps millions think.”

Lord Byron

The detection, diagnosis and treatment of disease is based upon the evidence collected by the diagnostician. In addition to knowing the chief complaint as well as the history and physical examination findings by the primary caregiver, the interventional pathologist should obtain and review any radiologic, clinical laboratory and other studies to help determine the optimal procedure to be performed on an informed, comfortable patient. Ideally, the interventional pathologist will have discussed the patient's case with the referring healthcare provider prior to the interventional pathologist's procedure; esp. in regard to the working differential diagnosis and co-morbidities, if pertinent. It has always been the standard, in the author's practice, for the interventional pathologist to personally schedule a pre-procedure interview with the patient prior to the interventional pathologist's procedure and to perform a "focused" physical examination on the patient verifying any physical findings noted in the patient's medical record.

Also, during the pre-procedure interview with the patient, the interventional pathologist should answer all the patient's questions as well as describe what happens, step by step, during the procedure; the risks associated with the procedure; the use of technology (ultrasound or CT guidance); the alternatives to the procedure and the potential benefits of the procedure. Informed consent, in writing, should be obtained personally from the patient by the interventional pathologist instead of the informed consent being obtained by other healthcare providers. Informed consent consists of not only permission to perform the operation or procedure but also consent for the administration of sedation or anesthesia, if needed or if requested by the patient. If possible, the patient should also be given an estimate of the technical and professional charges that will be incurred for the procedure and the likelihood of insurance coverage to offset these costs.

During the pre-procedure interview with the patient, the interventional pathologist must question the patient about any bleeding disorders, easy bruising, allergies (medications, tape, latex, Chlora-Prep, Betadine, etc.) , use of aspirin or coumadin, other medications or dietary substances that may interfere with hemostasis ( Gingko biloba, Vitamin E, fish oil or omega-3 fatty acids), adverse reactions to local anesthetics (such as during past dental procedures) and whether or not the patient is planning or wants to take a sedative or tranquilizer prior to the biopsy. Aspirin and anticoagulants may need to be discontinued for a certain amount of time, before and afterwards, depending up the nature and extent of the interventional pathologist's procedure. The interventional pathologist should also tell the patient the anticipated timeline and how the patient and his healthcare provider will be notified about the outcome and results of the procedure in a formal written report.

The patient should be given verbal and written instructions to be followed before the procedure, on the day of the procedure, as well as after the procedure. These instructions, including followup instructions, will vary depending upon what procedure (fine needle aspirate, core biopsy, sampling of CSF, ascites or pleural effusions, etc.) is being performed. The goal is to attain a successful outcome, with no complications, from an informed, comfortable patient.

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Byron L. Barksdale, M.D.

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