Melina Flanagan, MD MSPH
Board Certification: Anatomic and Clinical Pathology; Cytopathology
Medical School: Tulane University School of Medicine
Residency: University of Pittsburgh Medical School; Fellowships: Magee Women’s Hospital
Faculty Rank: Associate Professor
Special Clinical/Research Interests: Cytopathology; Breast and gynecologic pathology, Undergraduate and Graduate Medical education
I will happily work with any medical student that would like to work with me as they navigate their careers as physicians. I can offer particular guidance to those considering a career in pathology. I have expertise in supporting the needs of female and/ or first-generation medical students, and I am strongly committed to supporting the needs of BIPOC and LGBTQ students
Pathology is a vast field with many options. Your practice can range from very general (in which you are responsible for aspects of both Anatomic and Clinical Pathology) to subspecialized (in which you may see cases from only one organ system. You can work in academic medicine or in private practice.
I am an academic pathologist. I focus on surgical pathology with a specialty in breast and gynecologic cases, cytopathology, and medical education. On surgical pathology I look at slides under a microscope from surgical procedures and make diagnoses that impact patient management (Is this cancer? What kind of cancer? How far has it spread? What treatments is this patient eligible for?). Frozen section service involves looking at cases while a patient is in surgery and making immediate decisions that impact treatment during that surgery. On cytopathology, I make diagnoses under a microscope on fine needle aspirations, body fluids, and pap tests. Cytopathologists also perform fine-needle aspirations on patients (one of the few areas pathologists see patients) and on-site evaluation services during clinician-performed procedures. In our institution the work is structured so these are each “services” that pathologists do a day at a time; in other places you could do all of these on one day. In between clinical work, I direct the medical school pathology course and teach medical students, pathology residents, and anyone else rotating through our department. Every day is different, and sometimes what I think I’ll be doing when I start the day is nothing like what I’ve done by the end!
In anatomic pathology, you take what you see and use your understanding of mechanisms of disease to make decisions about tissue specimens that translate into action items for patient care. Yet, not everything is black-and-white: there are degrees of certainty as to whether something is a particular diagnosis. You have to be comfortable with uncertainty and making a diagnostic decision and report in the face of that. Additionally, with more and more data and information, the field of pathology is becoming so vast that is increasingly difficult to practice all of it.
The two “disruptive” forces in pathology are digital pathology and molecular pathology.
Pathologists have used microscopies to make diagnoses since time immemorial; however, it is becoming more and more possible to do so on digital platforms. Pathologists at some institutions do this regularly, while others are just starting to use the technology. I imagine that in the next twenty years this will become the norm.
Molecular pathology involves using molecular techniques to characterize tumors as to site of origin and/ or guide treatments. Making a diagnosis by visual analysis is, at this point, necessary but not sufficient. That said, I do not foresee a day in the near future that the visual analysis of a specimen, by some means, will no longer be part of pathology.
While our tools for making diagnoses are rapidly changing, there will always be a human body that the tissue comes from. There will always be a need at some level to work with that actual human being. I think the changes in our field only make it more exciting.
Pathology is unlike most fields of medicine in that it is not “patient-facing” (with blood-bank and cytopathology being the notable exceptions). It is very cerebral and, at least in anatomic pathology, very visual. Being able to be a pathologist rests on having a complete understanding of histology as well as mechanisms of disease. Thus, my advice is: 1) learn your histology. You have to understand and navigate “normal” to be able to diagnose “abnormal”. 2) Spend time shadowing or doing rotations in pathology to make sure that you like the daily routine. 3) While on your non-pathology rotations, “follow the specimen” (for surgery or procedurally-oriented fields), and/or think about the laboratory tests. All of that is being handled by a pathologist or in the pathology laboratories. 4) Get to know your friendly neighborhood pathologists. We often have projects or initiatives that can involve medical students!