121: How Pathology Images Can Transform Cancer Understanding w/ Dr. Lija Joseph

In this episode of the Digital Pathology Podcast, I sit down with Dr. Lija Joseph, a pathologist who is redefining patient care by making pathology more accessible and understandable. Traditionally, pathology has been a “behind-the-scenes” specialty, but Dr. Joseph is changing that by directly engaging with patients, showing them their pathology slides, and empowering them with knowledge about their diagnoses.

🔬 Key Topics Covered:

• [00:00:00] Introduction to Patient-Centric Pathology
• [00:01:00] Meet Dr. Lija Joseph: Her Background and Journey
• [00:05:00] The Patient Who Inspired a New Approach
• [00:10:00] Why Patients Need to See Their Pathology Images
• [00:15:00] The Power of Knowledge: How Patient Awareness Improves Care
• [00:20:00] Overcoming Barriers to Patient-Pathologist Communication
• [00:25:00] How Digital Pathology Can Make This Scalable
• [00:30:00] The Role of Technology in Breaking Down Access Barriers
• [00:35:00] Convincing Healthcare Leadership to Support This Initiative
• [00:40:00] How Digital Pathology Can Transform Patient Outcomes

🩺 Why This Matters:
Most patients never meet their pathologists—but should they? Dr. Joseph believes so. She shares powerful stories of how patients who see their own slides gain a deeper understanding of their disease, make better treatment decisions, and experience greater peace of mind.

🚀 How Digital Pathology Can Change the Future:
Dr. Joseph’s approach is innovative, but digital pathology can take it even further. Imagine a world where patients don’t have to visit a hospital to see their biopsy results but can access them remotely through secure digital platforms. This technology has the potential to bridge the gap between patients and their pathologists, improving care and trust.

🎧 Tune in now to learn how pathology can become more patient-focused!

#DigitalPathology #PatientCenteredCare #PathologyInnovation #AIinHealthcare

Transcript

Introduction to Patient-Centric Pathology

Aleks: [00:00:00] If you would estimate without people being actually told, Hey, you can see your tumor, you can see your pathologist, how many people would ask for that?

Lija: I know that Google has a billion hits asking for medical-related searches. There are so many patients who when they search their disease condition, this is an amazing forum for patients to reach out to their pathologists. There are barriers to this program, but I think once it is universally available, there will be more patients who will be interested in knowing about their disease. I have consistently heard from patients that knowledge is power. That is the exact words they use when they meet with me and they say, “Dr. Joseph, I cannot explain to you how important it is. Your conversation with me has empowered me. To take control of my disease.”

Intro: Learn about the newest digital pathology [00:01:00] trends in science and industry. Meet the most interesting people in the niche. And gain insights relevant to your own projects. Here is where pathology meets computer science. You are listening to the Digital Pathology Podcast with your host, Dr. Alexandra Zhurav.

Aleks: Welcome my digital pathology trailblazers.

Meet Dr. Lija Joseph

Aleks: Um, I don't know if you've seen videos from the digital diagnostics summit, but this is where I met today's guest, Dr. Lija Joseph. Welcome Dr. Joseph to the show. 

Lija: Thank you. 

Aleks: Dr. Joseph, Lija. I am so happy to have you here because you are a totally non-standard pathologist, totally the opposite of the stereotype of a pathologist.

Uh, my guest, uh, Lija is a, Patient-centric pathologist and at the Digital Diagnostic Summit organized by Lumea, she gave a talk about her patient-centric work as a pathologist, and I [00:02:00] thought that you guys need to hear it because It's basically anti pathologist stereotype and, uh, something that the patients need but maybe don't realize they actually can get it, can have access to it.

Dr. Lija Joseph, welcome to the show again and we start with you. Let's tell the digital pathology trailblazers about your background, you know, all the normal stuff that people need to know before you give a talk. And then we're going to dive into the questions and to into your non-standard pathology work.

In addition to your standard pathology work, because you're a diagnosing pathologist as well.

Lija: Thank you so much, Alex. And thank you for allowing me to share my story here. I am a storyteller. So. Always, um, enjoy an opportunity to share some of the stories that I have. Uh.

Aleks: Storytellers are the [00:03:00] best guests for podcasts.  When you said that, in the Digital Diagnostic Summit, I'm like, oh, I wanted to tell this story to the listeners.

Dr. Joseph's Background and Journey

Lija: So I grew up in India. I finished my medical school there. I moved, um, to the U. S. in 1992. Um, I've completed my pathology training in India and then repeated the same training again, similar training.

Uh, in, uh, the U. S. I did my fellowship in hematology, and I've been practicing since 2000, and I moved to this community practice in 2010. So, um, been in this field for a while, and so that's, that's my brief bio. Um, Primarily, I see myself as a patient advocate, and that is what I want to share in this forum.

Aleks: How [00:04:00] did you become a patient advocate? Because pathology and, you know, this stereotype, uh, when you talk to pathologists, it's not the case because they are very patient-oriented. But when you look across the specialties, the stereotype of a pathologist is like person who doesn't want to see patients, who is more introvert.

And, you know, over and over I see this is not the case. Like in my case, I am not introvert at all. And I became a pathologist because it was. fun topic and you could like learn about all the disease and I'm a veterinary pathologist. So that was on the veterinary side of things. But how did you become this patient advocate patient-centric pathologist?

The Inspiration Behind Patient Advocacy

Lija: So, um, it was a patient who inspired me to start this. concept. Uh, patient's name is Linnea. She started, um, with a [00:05:00] diagnosis of lung cancer. She wanted to see what lung cancer looked like. She lived in Lowell, but she couldn't find a pathologist in Lowell that she could connect with. So she drove 20 miles south of here to meet with, uh, my friend, Michael, who sat with her and showed her what, um, lung cancer looks like.

So when I read her story in our weekly journal club where we review, you know, current trends in pathology, I was deeply moved specifically because she didn't even want to see her own biopsy. She just wanted to see what cancer looks like. And I said to myself, if there is a patient in Lowell who wants to look at their biopsy.

They should not have to drive 20 miles. They should just come to Lowell General, which is within 2 miles of wherever [00:06:00] they live. And I should set this up so that they can view their biopsy or an example of what cancer looks like or an example of what anything looks like under the microscope. That started my journey, uh, towards starting this clinic.

Implementing Patient-Centric Practices

Aleks: So couple of questions and this, uh, you know, we met the, the summit was in September and since September and while I was thinking about this conversation that we're going to have a couple of things like when you start thinking about something, uh, then, you know, more and more corroboratory information comes your way.

And, um, I recently talked to Dr. Yuri Nikiforov. He has this, uh, world tumor registry and, Uh, he also mentions that one off the target audiences target people who he built it for is patients because you can. He has the plan to build [00:07:00] a digital repository of all the diagnostic entities of all the tumors that are out there.

He started with thyroid. That's his specialty. And and that was one. Well, after you were the first doctor that I know. Actually, no, let me show you something. The first doctor and she was also a guest on my podcast was Dr. Marilyn Bui. And that was my first encounter with, Hey, patients wanna see their tumors.

Patients want to understand what's going on in their body that is so threatening. And I read this book and the book is the healing art of pathology and it's totally not about pathology. Well, it is, but it's mostly about art, how people are dealing, uh, with their disease through art, seeing microscopic images.

So that was the first instance, but that didn't make me think so much yet. More stuff came at me this year. And, uh, your talk was one of the things. And the other thing, uh, was the, the world tumor registry, your [00:08:00] patients are those who are supposed to see it. When I think about it, it's like, Why is it not a standard practice?

Because whenever we go to a radiologist, we get our images. Whenever we get labs from, you know, primary care physician, wherever, any other specialist, we get all the data about ourselves. Um, and you know, depending on your savviness or your, like, level of expertise, you can interpret it. You can go to, uh, people who can help you interpret.

You can talk about it with your doctor, but not about pathology images. This is, like, totally unknown. How Often, like without, um, actively promoting it because now you are, um, suggesting people, uh, talk to the pathologist and we're gonna, I want you also to talk about this article that you mentioned in the summit where, uh, there was a problem with patients seeing physicians.

Challenges and Successes in Patient Engagement

Aleks: If you would estimate without people being actually [00:09:00] told, Hey, you can see your tumor. You can see your pathologist. How many people would ask for that? How many people would be interested, like in the general population?

Lija: I think there are two dimensions to answer that question. I know that there is data that on any given day, Google has a billion hits asking for medical-related searches and uh, Dr. Vasserman who has started my pathology report on ca which is one of the sites which Um, he said has patients who speak 25 different languages who go to his website to understand about diseases and, um, close to a million hits a day.

Aleks: Oh my goodness. I'm going to pull this website right now.

Lija: And also Dr. Nat Pernick, who, um, does the pathology outlines, personally shared with me that there are so many patients [00:10:00] who, when they search their disease condition get directed to his website and they reach out to him saying, can you explain this to me? You know, so he, he said that this is an amazing forum for patients to reach out to their pathologists. The barrier honestly is them not knowing about it. And that I think is the reason why three to four patients come to meet with the pathologists in person every month in our program. And we've had this program since March of 2017. So before the pandemic, through the pandemic, after the pandemic, we've met with over 250 patients. Most of the times the patients come to us because their primary team refers them to us. We recently started adding a note to the pathology report saying pathologists are [00:11:00] available for you to review your biopsy.

But all of that is dependent on the patient actually accessing their report or making that effort to find out more about their disease. There are barriers to this program, but I think once it is universally available, I think there will be more patients who will be interested in knowing about their disease.

I have consistently heard from patients that knowledge is power. That is the word. Um, exact words they use when they meet with me and they say, “Dr. Joseph, I cannot explain to you how important it is. Your conversation with me has empowered me to take control of my disease.” I call it their wellness journey because we are all living and dying at the same time.

You know, as we live, it will be good to be well  in that process.

Aleks: Amazing. So a step back, you say that [00:12:00] they would, the patients would need to actively inquire for the pathology report. This is not something that like go, they get, the oncologist gets the report, right?

Lija: Honestly, since the, the reports are readily available to the patients in the patient portal, they can access it.

But all of this requires an active engagement by the patient. To go online, go to a computer, uh, log in, register. Uh, their name and, you know, get their access set up. Once they do that, we have patients who get notification on their portal. As soon as we release the report, it gets on their portal because that is the requirement of the Cures Act.

Those who have that. As soon as I hit send, within five minutes, I get a phone call from the patient. I want to know what that report is. And you know, we welcome that. We explain to them, there's so many [00:13:00] patients who are just so happy when they say, no, it's not cancer. Everything's good. Your doctor will be calling you soon.

That sigh of relief is just amazing.

Aleks: So it's not different than any other specialty for your, um, healthcare institution sets up for you to access these things. You always need a password and it has to be compliant. But once you get in there, you get access to that and then you can contact your pathologist.

So, so the first step is, um, let's say a phone call explaining what's in the report.

The Process of Showing Pathology Images to Patients

Aleks: How does it get, and how did you come up with this idea? How did you even start showing the images to them? 

Lija: I know. 

Aleks: That's like another level, right? Because a person talking to a person explaining like a doctor explaining in a non-doctor speech what's going on in your body is one thing.

The other thing are the images. So analogous to radiology. Okay. The radiologist can show you something and sometimes [00:14:00] you see it if it's broken and obvious, you see it. Uh, most of the time you probably don't see it. Uh, I like try to pretend I see what he's showing, but most of the time I don't, but they do look with you at the images, right?

How did you transition to doing that with patients and how do we do, how do you do it logistically?

Lija: I think honestly, this was not something that I was taught in residency. I did not see somebody model that for me. And I hope to change that for the current residents who are in the college.

Aleks: I can already tell you, you are a model for several people. More people will see you through this video and they will be able to model that. 

Lija: So what I want to, um, I want to call this what Dr. Abraham Virgis mentioned as a ritual. Every patient that I met with taught me something. And I have honed that skill to a process that I now believe, um, has educated me. My experience as a faculty at [00:15:00] Boston University, at University of Arkansas, at Tufts Medical, um, Tufts University, my role as a faculty and as an educator has helped me use words that I can make a student understand, and I have used that skill in, um, helping my patients.

So, my logistics, my ritual, it starts with introducing myself. And I have a funny story about that. 

Aleks: Yes, please tell the story. 

Lija: I'll get to that at the end. 

Aleks: Oh, okay. 

Lija: Uh, uh, so I introduce myself. I ask the patient their name, and date of birth. I bring because I've never met them before. So I want to be sure that I'm speaking to the right patient.

And then I have a consent form that the hospital lawyers have created for me, basically saying that the patient is here to view [00:16:00] their medical records. So our hospital sees the patient's glass slide. Okay. as part of their medical record.

So they sign off saying that they are here to view their biopsy. Uh, before I, um, the technical team in the lab on the days that I have the clinic would have gone in the morning.

My clinic is Tuesday afternoons between 1 to 4 p. m. So Tuesday mornings at our morning huddle, we will um, notify our team that we have a patient coming at two o'clock today. So they would have gone up to the clinic area, set up the microscope, set up the TV screen. They would have set up everything for me.

Um, they would have pulled the slides for me. They would have filled out the consent form. So when I go to meet the patient, I am just interacting directly with the patient. I bring a, um, example of a tissue cassette. [00:17:00] I bring an example of a paraffin block. I bring a ruler with me. If I'm meeting with a breast cancer patient, I bring a picture of broccoli so that it helps me explain, um, alveolar, you know, duct globular unit.

If I'm meeting with a prostate cancer patient, I bring an anatomic, uh, image of um, where the prostate is located so that they can understand what I'm explaining. So I always spend two to three minutes, the background of how something that looks flesh colored. becomes purple and pink on a TV screen. There is one moment that I always make sure happen, and that is for the patient to see their name on the glass slide.

Really, over the period of time as I met with many patients, that is truly an aha moment for them, and it has It's always stuck in my mind because they [00:18:00] could easily go to Google and see random pictures of any disease. You just have to click images and they would see it. But when they see their own image, it's something transformative for them.

So that I always do. And on the glass slide, I always go to normal. If at all there is normal, I always show them normal. And then I show them abnormal. And that, um, transition is important for them because they have no clue and so it's important for, Oh, that is what it looks like. That's what it should look like.

And this is the transition that has happened. And that helps them.

Aleks: A couple of things I want to highlight here.

Ensuring Patient Understanding and Engagement

Aleks: You, you said, okay, so, so the whole process of actually like showing the tumor. Uh, in an informative way. So the whole like background explanation doesn't take more than five minutes, right?

Lija: It really doesn't take more than five minutes.

And if you take more than five [00:19:00] minutes, they will tune out. So, you know, that is important because they're here to see something specific. My interaction with the patient usually is no more than 30 minutes, so right soon after I show them, um, and introduce myself, I ask them, do you have specific questions, because all, if all the questions they have is about radiology, you know, I shouldn't waste their time or my time.

I have to send them to the right source. I always ask up front, and that is also part of my ritual that I've learned over time. But I want to share this funny story with you. 

Aleks: Tell me. 

Lija: Because I, I went to, so most of my patients are, um, breast cancer patients. Um, because the surgeon is so invested in this program and you know, uh, if you watch my YouTube video, she's on that video.

She says, this is amazing. It really helps them.

Aleks:  I'm going to link to this video. You showed it at the seminar. I'm [00:20:00] going to link it in the show notes as well.

Lija: So I went up there to the clinic, which is in the actual clinic area. Let's say The patient's name was Joan Smith. The patient, uh, Joan Smith had shown up for her clinic appointment with me.

So I go to their waiting area, I call the patient's name, I bring her in and I said, I'm here to show you your breast biopsy. And if there is anyone accompanying the patient, I always ask the patient's permission to bring them into the room. So the patient's Husband was also in the room and they were a 70 year old couple.

The husband turns to the patient and says, did you have a breast biopsy? And the patient says, I don't remember having a breast biopsy, but maybe I did have a breast biopsy and maybe I forgot about it. 

Aleks: Oh my goodness. 

Lija: I had a medical student shadowing me at that time and the light bulb quickly went on in his mind [00:21:00] because I was struggling to figure out what's going on.

He said, Dr. Joseph, let's just check the date of birth. And so two patient identifiers, this is, you know, always follow the rules. And when I asked the date of birth, it was a different Joan Smith who had come to see the genetic counselor for something completely different. And my patient was still sitting outside wondering, where's Dr. Joseph? 

Aleks: Oh my goodness. And see, now I know why they always ask me when they bring kids like, what's the name and what's the date of birth? 

Lija: Yes. 

Aleks: And like everybody asks that and by the like third person that asks it, I'm like, I already told it twice, but you know what, now I'm not going to be so annoyed anymore.

Lija: But it's that interaction between the couple that was so sweet. Maybe I did have a biopsy. Maybe I forgot. It was so sweet.

Aleks: Yeah, I guess you wouldn't forget if you had the breast biopsy, but that was cute. [00:22:00] Okay. So you found your patient, but, um, let me go back to you being so focused on giving the patient what their need in this clinic, uh, which I think the more we practice, the more we lose this ability to, um, Or maybe we don't lose it, but we need to focus on it more to always bring it to the surface and be super clear without dumbing things down.

And there was a quote I recently heard. Never underestimate your patient's intelligence, but never overestimate their prior knowledge. So to meet those five minutes that you're doing, and I try to do it in the podcast and, you know, literature reviews as well, always bring somebody who comes to listen to me to the level where they can keep following everything without feeling like overwhelmed.

And tuning out. So it cannot be too long, like you said, and it has to be, um, in their [00:23:00] language, bringing them exactly to the point, uh, to what they want to get out of this particular visit. And like you said, if they want to see the radiologist, then they can go and see the radiologist. They don't need to sit at the microscope.

Accessing Medical Records and Pathology Reports

Aleks: One question about the medical records and maybe it's different in different institutions are trying to investigate it a little bit and figure it out. So if I was diagnosed with cancer and had a biopsy at a hospital that doesn't digitize slides, how can I get access to my medical records?

Lija: Yeah.

Aleks: Show up and say, I want to see it or what's the procedure?

Lija: So there is a medical records department which you can communicate with. I mean, if you have access to a computer, your medical records. 99% of the time is accessible online. 

Aleks: Okay. 

Lija: So thereI have had patients who have requested to get on a Zoom call

Aleks: mm-hmm .

Lija: To view their biopsy. I've had patients who want a PowerPoint image of a specific portion of their [00:24:00] biopsy.

I've had a patient who, uh, came to print. a copy of a Reed Sternberg cell so they could take it back to their family in Brazil to show them what a Reed Sternberg cell looks like. So there are, there has been at least two or three patients who wanted to take a picture of their tumor, keep it right next to their medication.

So when they take their medication, they would imagine the tumor melting away and, you know, use the power of positive thinking. It doesn't matter to me what the patient needs is what we as pathologists have to provide. And we make that diagnosis. And I feel very strongly that the patient should come to the source who made that diagnosis.

Why should we hide behind a paraffin curtain? We should be readily available to the patient. So, medical records department is our [00:25:00] patient advocacy office. Our two resources that anybody can access. in order to meet with their pathologist.

Aleks: I love the sentence, what you just said, anybody should be able to come to the source.

And I remember you saying that in your talk that, hey, if they don't come to the source, it's going to be Google. It's going to be ChatGPT. It's going to be whatever.

The Importance of Doctor-Patient Interaction

Aleks: And how can you guarantee that it's going to help them. It's going to give them some information, uh, hopefully correct, but how will you guarantee that you're actually helping?

And this human, this doctor patient interaction is. What allows you to see, are you, are you bringing them where they want to be? Are you helping them? Like you mentioned, uh, are you like giving them the empowerment that this picture next to the bottle with medication will give this person if they practice, you know, visualization, positive thinking, whatever methods they're like using to increase their [00:26:00] wellbeing now with this consult, you gave it to them before it was super abstract.

Lija: I want to share. Two stories that come to mind as you were sharing this with me.

Story of an Elderly Woman with Gastritis

Lija: One is a 84 year old woman who was diagnosed with chronic inactive gastritis. When she tried to reach her GI doctor's office, they said, everything's fine. You can come back in one year for your follow up appointment. You don't need to worry about it.

And the only way that the patient could actually access a doctor was to talk to the pathologist. So when we met with the patient, the patient said, I cannot thank you enough for finding 30 minutes to talk to me because I have changed my diet. I have gone online to see what else I need to do in order to deal with my gastritis.

I didn't know if this was going to go to cancer because she read something about H. pylori gastritis leading to lymphoma. Amount [00:27:00] of anxiety that the patient was under and not being able to access a person who would reassure them. Of course, when they're calling the GI doctor, they're just getting to the front desk.

You know, the barrier is right there. to prevent them from interacting. They go on this spiral of, I just need to talk to somebody. All it took was, you know, 20 minutes of our time. The level of gratitude that the patient expressed gave us such deep professional fulfillment. It was just a moment that I will never forget.

Breast Cancer Patient's Journey

Lija: The second story is about a breast cancer patient who, when we sat at the microscope and looked at the estrogen receptors, this was a patient of a different ethnicity who had pretty severe distrust of the medical system and was Um, considering that as a barrier in following their treatment that was [00:28:00] prescribed to them.

And the patient said, if only I had seen what estrogen receptors are present on my tumor cells. And if somebody had explained to me. Why taking that anti-estrogen medication is beneficial to me? I would have been so much more compliant with my treatment. She had stopped taking after two years. She said, I don't want to deal with it.

And she said, I'll go right back on it right now.

Empowering Patients Through Education

Lija: And those are the kind of stories, you know, a patient with diabetes who came to view their, um, skin biopsy said. “Even if I'm driving a Mercedes Benz, if I don't put the right oil under the engine, my Mercedes Benz is not going to function. Thank you for explaining to me why this disease process happens and what the impact of my own personal choices would impact my wellness journey.” There are so many stories like that. Every time I see a patient, I say, [00:29:00] this is just a flash in the pan. Nobody's going to come back again. And the next patient will do something, say something inspiring to me. And it truly kept me going through COVID. You know, when things seem to be falling apart all around us, the moments when they would come and say their level of gratitude showed me that My troubles are really not that much.

32 year old immigrant woman who had just had her baby and six month old baby, she wanted to start her own clinic, uh, sorry, her own daycare and opened the daycare and now has Her2 positive breast cancer. But the level of enthusiasm that the patient comes with, I want to see what's going on. I want to take care of it.

I want to get back. My business started back again. Those are moments of inspiration that I didn't prepare for this podcast. These [00:30:00] stories just come to me, you know, as, um, skilled as you are to, you know, to bring those stories to life. I just want to let you know that it's happening. It's unbelievably fulfilling.

Pathologists' Unique Role in Patient Care

Aleks: Those stories that you just say and, you know, that keep coming to you, they emphasize something that I think is underutilized as the pathologist's expertise, is the under, the comprehensive understanding of pathophysiology. of the disease. We are uniquely qualified to explain these things to people because that is what the pathology training is.

There's always this joke, oh, uh, the intern, no, what is it? Surgeon doesn't know anything, but they do stuff anyway, very fast. The internist. I don't know. There's like, there's a joke, uh, like about different specialties.

Lija: Yes, pathologist knows everything, but it’s too late. 

Aleks: Exactly, pathologist knows everything but it's too late because everybody associates pathologists with autopsies, which is [00:31:00] not their case.

Uh, but this, like this knowing everything is part of the specialty as part of connecting everything. And also the taking out the pressure off fast treatment decisions gives us this unique capability and this unique superpower to actually talk to people and explain options like also justify treatments like you said.

People. People don't know. People like are afraid of certain classes of drugs, like the biologics. Um, and I had a similar situation, uh, in my friend's circle where somebody was, uh, asking about a biologic for, I don't know, a skin condition or something. And they thought it was something so bad because you're going to have to take it to the, uh, for the rest of your life.

And like when they understood the benefits and actually the like you could get rid of your disease. You can mobilize your immune system with this particular class of drug. [00:32:00] It totally shifted their, um, their compliance and their attitude towards, um, towards the treatment. Right. But it wasn't The treating physician who even had the opportunity to explain this, and I think maybe patients are more intimidated to like, ask questions about alternative things to somebody who's treating them because it still comes across in the society as undermining somebody's authority.

Whereas pathologists is just. talking about the disease. That's the perfect person to talk, right?

Explaining Medical Concepts to Patients

Aleks: Going back to when you have the patients, you've explained it for, um, five minutes, more or less. You both are on the same page regarding, okay, what needs to be explained and what they want to get out of the consultation. Then you sit at the scope, right?

Lija: So, I sit at the scope, but the images are actually…

Aleks: O, you project them…

Lija: … projected on a TV screen. Um, and so that is easier for [00:33:00] them to understand. And I explained to them that although on the TV screen, it looks large, we are using magnifying lenses so that they don't think, wow, that is a lot of tumor.

So that's why I bring the ruler with me and I actually on the glass slide, I share. The size of the tumor or something with the ruler so they understand most of the things we are talking about millimeter, two millimeters, five millimeters, something like that. So, um, I tried to make sure that they understand scale, which is easier for them to grasp once we show them a ruler.

Aleks: Do you also discuss the stage, the margins, anything? about that or depending on the patients, how do you, how do you deal

Lija: Yeah, with breast cancer patients? I explain it to them like a rubik cube. I say, imagine a rubik cube. And we are painting different colors of the lumpectomy [00:34:00] specimen and anything that is beyond the color is still in your body.

And so that really helps them understand margins. And I also, um, explain to them the receptor's, um, status. So that they, after I had that patient who talked about the compliance issue, I always explain to them why it is. important that they take their medication. Some patients ask questions that are not related to our field, but what I have done is I always assure the patient that those questions are beyond my scope.

But I will let the primary team know that this is a question that they still have unresolved in their mind. And often when I am done with my patient clinic, I send a message to the team that is responsible for that specific question. And they interact with the patient saying, thank you for meeting with [00:35:00] Dr. Joseph. She communicated with me that you have some concerns about. X, Y, or Z to the patient, it creates a sense of the team that is there to take care of the patient. And indirectly, it puts the patient in the center and all of these team members are interacting. in order to get that patient the best care they need.

So I had a patient who, um, had a mental illness. Based on the conversation that the patient was having with me, I alerted the social work team and said that this patient may need additional support. And they found out that the patient had stopped taking their medication and, you know, needed, um, a comprehensive plan in place so you never know which direction that additional support may need to be leveraged.

It's important that you put the patient in the [00:36:00] center. And that always solves the issue for you.

Aleks: And that brings me to something I mentioned, I mentioned at the beginning. You quoted this paper where there was an, uh, you wrote an editorial, like a response to the paper that, hey, the pathologist will see you, even though there is a shortage of physicians to actually see the patients were here and, um, that was at the beginning of your talk.

So when you were talking about that, I felt like you're annoyed that there are no doctors to see the patients and you're a doctor who can see a patient. So can you talk about this story as well?

Lija: So this was an article that I saw in Time magazine, um, which said that your pathologist will not see you now.

Uh, sorry, your patient, your doctor will not see you now. And as soon as I read that article, I said, wow, that sounds so similar to the editorial I wrote a couple of years ago. Your [00:37:00] pathologist will see you now. And so that was, um, The kind of connection that I was trying to make that often patients are struggling to connect with their doctor or their primary care team because of the way the system exists in the U.S. right now. And here is a group of doctors who are eager to meet with the patient and the patients are not accessing it yet. So I really want to leverage any possible forum to get the message out that there is a group of pathologists. waiting, ready to meet with you.

Aleks: You say four people a month, more or less, join the clinic.

Challenges and Solutions in Digital Pathology

Aleks: Do you think if that would be available online, if there was digitization, if digitization was standard, um, I assume it would be easily scalable, right? 

Lija: Yes, it's [00:38:00] easily scalable. And that is something that I really hope that your digital pathology place audience utilize because there, we get two to three phone calls a day.

But three to four patients a month because the whole logistics of showing up, getting to the clinic, finding the pathologist, setting up the appointment. In this day and age, when pathology slides can be digitized and you can access it online, how many more patients can utilize this resource and speak to a pathologist if we had digital pathology?

Accessible to people watch YouTube videos streaming on their cell phone. So, you know, looking at a slide is not that complicated. Um,

Aleks: Yeah, I like the slide videos all the time from, you know, virtual slides from Pathpresenter, even from I have a camera on the microscope. [00:39:00] Uh, I sometimes use the phone and I do a lot of this.

Leveraging this to communicate how the disease looks like an answer patient questions like how do you see this happening? Because it has not happened yet. You're either the only one or one of the very few people who are doing it. And there is nothing preventing somebody specifically in an institution that is already digitized to model what you're doing.

And. basically do it on digital. Where do you see the hurdles? Like, what's the problem?

Lija: I think, you know, clinic space is always premium. So organizations, leadership, C suite is always looking to see if I give you that clinic space, what's my return on investment, you know? So, that is a barrier. How to set it up, how to find a CPT code that is appropriate for reimbursement. for these kinds [00:40:00] of encounters. That is a barrier. How to provide a HIPAA-compliant safe space where you have a support staff who will set up the microscope for you, who will set up the TV for you. That is another barrier. But a lot of these barriers can be, um, resolved easily by your audience because All they have to do is come to, click on a link, and come to a space, and the pathologist is there, the patient is there, the slides have been uploaded, and then you have a conversation.

It would be a beautiful world that would empower a patient, helping them to understand their biopsy, their slides. Their journey to wellness through this process. It is possible.

Aleks: I'll encourage any pathologist who's listening to this or you know, any other physician who can talk to a pathologist and they think [00:41:00] this pathologist would wanna do this on digital slide to reach out to you on LinkedIn.

I'm gonna link to your profile on LinkedIn, uh, and ask how to do it because I think this is fantastic. And there is one thing that, um, was super important that you said at the, um, at your summit talk. And you started touching on it right now, the return on investment, and you said that the patient voice is the one that is heard the loudest by the C suite.

And when I heard that, this is the key to promoting digital pathology because if the patient requires requests that and asks for that, this is the voice that's going to be heard by the management. It's not just going to be. Oh, pathologists want to be more comfortable. Pathologists want to work remotely instead of on glass.

It's going to be a totally different dimension. It's going to be the, um, telehealth for pathology, [00:42:00] which, uh, You know, this is an image-based specialty, so totally plausible to set up a HIPAA compliant telehealth option of those clinics. So yeah, if you can, uh, talk about the relationship between patients.

And how it was in your case, uh, in, in your, uh, community hospital, like how did the C suite react to this? How did you, first, how did you convince them to, to start it in the first place? Like how did you overcome the hurdles that you just mentioned that, you know, clinic space, what's the ROI and all that stuff?

And As you, um, already were successful in this, what did they say, uh, what made them, uh, keep this initiative going?

Building Relationships with the C-Suite

Lija: I have to say, it's all about building relationships. So, you know, I have been working here for six years before this idea came to me and I was able to launch it in three or four [00:43:00] months because I was present to the C suite.

They knew my name. They knew who I am. I would present at meetings. We are five pathologists. We are not a huge department, but we would attend social events. We would attend fundraising events. We would be visible to the C suite. So they knew who we were. Then we made sure that the care that we provide is excellent.

Because at the end of the day, our professional expertise is what is our, um, shining light. So once they know that this is an excellent group of pathologists, they are an engaged group of pathologists. And now they're asking for this one thing. At that point, the goodwill was already there.

Aleks: Then you say, why not, instead of not?

Lija: Why not? [00:44:00] And when I asked our CMO, why did you support this program? He said, no patient ever has sued a doctor for talking to them. Patients sue a doctor when they feel like the doctor's hiding behind a curtain, it's not open, is not sharing.  When you interact with a patient, when you explain to them, even when you make a mistake, which has been proven in the state of Massachusetts, when you disclose and apologize, even if a mistake is made, that patient is highly unlikely to sue you because they understand your vulnerabilities and that is something that is a mindset that an earlier generation has tried to put in our heads that, you know, never ever be vulnerable, always be firm, always stand by your diagnosis.

That's not my experience interacting with [00:45:00] patients. Even if there is a slight deviation one way or another. The patients are so much more forgiving when you interact with them directly and when you explain to them, this is the reason, this is what happened. I know this, um, because I have been sued and I wish I had an opportunity to meet with that patient and explain.

This was the reason why I made that diagnosis, but I never had that opportunity. And so. I'm not afraid of a lawsuit because I've walked that path as well.

Aleks: Wow. So two things that shine through this story. First, the visibility of our specialty. I'm hearing this more and more often. Let's shine. The light of this specialty and you you just gave two example how to do it.

Be there as you know, as an engaged group, not the stereotype people in the basement, just pushing glass. [00:46:00] And second, be an excellent physician. Be just basically focus on excellence in your specialty. That's the first thing to shine the light on pathology as a specialty because I don't know if people even know what pathologists do, uh, if they're not actually actively, uh, in cancer treatment journey.

And the other thing, and this is super important now in the era of, uh, information overwhelm, information, accessibility, uh, different, you know, AI tools that bring you all the freaking information you can like summarize the whole PubMed or wherever you take your medical information. People have access to that.

You don't have to now show off with knowing stuff because everybody can notice stuff. Also, like at a different level, people ask, like, why, why do people still buy courses or go to workshops? They can get this information because they want to hear it from a person [00:47:00] that they have a relationship with. And you know, I see it through the podcast.

I meet people at conferences and they listen to my stuff because they resonate with the way I teach. They can get this information anywhere. And now this like relationship aspect off. Um, yeah. Patient-doctor interaction is so much more important. Like you say, the information is out there, the, um, possibility of a mistake is probably greater than ever because you have more treatments than ever.

You have like more research coming at you every day, uh, and, and there's no way, uh, to keep up with this if that's not your main job. And if your main job is diagnosing or treating, uh, patients, then doing literature research is not your main job. Yeah. So like putting. the emphasis on their communication with the patient.

First, just because of the, um, Like, I [00:48:00] don't know, bad publicity, bad light that healthcare is now in where there is a big disconnect. And, you know, on both ends, patients being annoyed with doctors not being accessible, doctors trying to protect themselves because there is a huge issue with burnout at all specialties.

I think people choose pathology because it's less burnout prone, but basically this relationship peace is super important. And then this being tied to, uh, to this argument, Hey, uh, no patient sued a doctor, which I just had recently this year, medical malpractice lawyer as a podcast guest who uses digital pathology, uh, to defend, um, doctors.

And basically, um, she uses it for, um, unbiased review. So, like she gives the images to the doctor as the cases was unraveling instead of like giving the whole package and [00:49:00] basically, uh, from the get go biasing the expert with, Oh, I know the outcome. Uh, well, I see where it went wrong. So she does it the other way around, but the first step is to basically have a relationship.

Encouraging Patient-Pathologist Communication

Aleks: If patients are listening to this.  How can they get in touch with their pathologist? Like let's say random patient listens to this podcast and they would like to see their biopsy. They would like to see their resection, talk to their pathologist. How can they actively request this from their pathologist?

And by the way, they can also send a link to this episode. to their pathologist so that their pathologist knows how to do it. But if a patient wanted to do it, what should they do?

Lija: They should just pick up the phone, call the hospital operator, and say, can you transfer me to the pathology department? And you go to the pathology department, ask them, I am a patient, I want to speak to a pathologist [00:50:00] about my diagnosis, and is there anyone available to speak to me?

That is all it takes and if no pathologist is willing to speak to you, then you should call another hospital and go to another pathologist. They can always call me.

Aleks: Good. So if there was something that could happen after this episode, if there are people inspired with your journey on the pathology end or on the hospital end of things, what would you like them to do?

What's like the first step for them to set something up similar to what you did?

Lija: Send me an email. I'm happy to speak. I have. I have helped many hospitals start this program across the country. Be patient. I will respond to your email immediately, but your Um, C suite may not respond to your request immediately.

It might take two or three years to [00:51:00] launch the program, but, um, always believe in your patient. And I really want to quote what Linnea told me. Don't ever give up on your patients. There are hundreds of Linneas like me that are waiting to meet with their pathologist. Please don't ever give up on them.

Aleks: This is amazing.

Final Thoughts and Call to Action

Aleks: This is so heartwarming and empowering for both the, the whole specialty of pathology and for the patients. And thank you so much. I'm going to include your email and maybe you can, you can say it like spell it so that people who are listening. Yeah.

Lija: So it is lija.joseph@tuftsmedicine.org or lijjosephgmail.com either one of them.

Aleks: I'm going to include both of them in the show notes. So [00:52:00] anybody who wants to, uh, follow your steps can reach out to you. Thank you so much for joining me. Thank you so much for those stories and for the inspiration, both for patients, for pathologists and all the other digital pathology trailblazers that can influence, um, The, the, the advancement of digital pathology, uh, as the gateway to faster and better care.

I believe, uh, digital, I believe patients have the right to fast diagnosis and digital pathology is the enabler of fast diagnosis and is the connection maker to your pathologist. So, you know, with digital, all the setup hurdles would be, uh, erased. Yeah. So I hope that, um, a digital institution, an institution that's already digitalized, reaches out to you to set something up like this.

Thank you so much.

Lija: Thank you. Thank you, Alex. Bye.

Aleks: Thank you so much [00:53:00] for staying till the end. It means you are a true digital pathology trailblazer. And I would love to ask you a favor. If you know a cancer patient that would like to talk to their understand their disease and be able to look at their slides together with the pathologist.

Please share this episode with them. And if you are a health care professional, a doctor, somebody who knows pathologists, and you know they would love to start an initiative like this, please share with them as well. Starting more initiatives like this. Can immediately improve patient care. And this is one of the few things that can be done by you right now, just by sharing it with somebody.

So I will very, very much appreciate and I talk to you in the next episode.