Re: "What to Look for in a Pathologist" (April, page 49). I am a pathologist, a medical doctor practicing medicine from behind a microscope, and not a vendor. Pathologists impact the lives of more than 70 percent of patients requiring medical care in the United States, either through clinical laboratory or anatomic pathology testing. To refer to a pathologist as a vendor is both inaccurate and unfortunate.

It's true that some pathologists have chosen to label themselves as vendors, either through their behavior (client billing or pod laboratories with piece rate compensation) or by identifying themselves as such to clinicians (called clients) and business associates. But when practiced in an exemplary fashion, pathology saves lives and healthcare resources.

Would pathologists who provide the full menu of services listed as "desirable" within this article - diagnostic accuracy, availability to review cases with clinicians, rapid turnaround time, clear reporting, emphasis on education - accept the title "vendor" or let a non-pathologist physician bill and collect for services the billing physician didn't perform? Not likely. Others, and they're out there, might not mind being called a vendor; but I at least wonder why any physician so integral to the care of so many patients would define himself with such a term. Perhaps if you were to refer to gastroenterologists as "colonoscopy vendors" or surgeons as "cholecystectomy vendors," you'd receive similar letters from your readers.

Julia Dahl, MD
Gastrointestinal and Hepatic Pathologist
Mosaic Gastrointestinal Research Consortium
Memphis, Tenn.
[email protected]

The word vendor for a pathologist (physician) is rather unbecoming, like describing the trade of inanimate objects in a futuristic mall. The surgical center's patient is every physician's responsibility, irrespective of the location of contact - clinician's office, surgery center or with a specimen in the laboratory. The ills of health care today can be greatly attributed to the conversion of the practice of medicine to a business stream lined to generate profit rather than to care for the ill. I am sure a pathologist takes as much pride in his work as anyone quoted in the article. Maybe a pathologist's opinion would have added true value to this article.

Name withheld upon request

Countless GI pathology groups are actively marketing themselves to serve the patients and physicians in surgery centers. Between local pathology groups, numerous regional groups and a growing number of national companies, this is a highly competitive space within the medical services sector of healthcare. With so many choices for surgery centers, I saw the intent of the article as providing ideas to help differentiate the groups based on quality and service.

John Poisson
Executive Vice President & Strategic Partnerships Officer
Physicians Endoscopy, LLC
Doylestown, Pa.
[email protected]

Surgical Site Marker Article Misses the Mark
Re: "Should You Use Sterile Surgical Site Markers?" (April, page 82). This article misses the mark (pardon the pun) on two key points.

First, most surgical markers use alcohol-containing gentian violet inks, whose agents are effective antiseptics. It's not surprising that cultures of used marker tips show no growth. Nor is it surprising that there are no immediate increases in surgical site infection rates with multiple-use markers, since the marked site is treated with yet another antiseptic agent (the prep). The dirty little secret here is that the barrel of the pen becomes the real vector for transmitting pathogens throughout the surgical environment. The question isn't whether you should use a sterile pen, but rather should you re-use marking pens. With MRSA colonization becoming increasingly more prevalent, the answer is an emphatic no.

For similar reasons, we should condemn the use of "special-order, self-inking rubber stamps." Unless thoroughly disinfected after each use, the device itself becomes a vector for the cross-contamination of pathogens. In addition, such devices don't use FDA-approved inks. They typically contain ASTM D4236 approved "non-toxic" inks that are considered to have no long-term toxicity effects with repeated incidental exposures, but aren't technically approved for direct, intentional use on human skin. And they're certainly not approved for contact with subdermal tissues, as can occur when the mark is made at or near an open surgical incision. Please start promoting the use of only FDA-approved inks (such as gentian violet and methylene blue) or else the lawyers are going to start blaming any and all surgical site complications on the use of non-approved marking devices.

Stephen Lober, MD
Head of Research and Development
OP-Marks, Inc., Surgical Site Markers
Bogart, Ga.
[email protected]