Clinical pathology covers a broad range of responsibilities and functions in medicine. As a discipline, it includes clinical (bio)chemistry, medical microbiology, hematology, coagulation, clinical immunology, and increasingly molecular diagnostics. We recently sat down with the Editor of the American Journal of Clinical Pathology, Dr. Michael L. Wilson, to learn the vital importance of this field. Dr. Wilson also shares with us his insights on his journal’s readers, authors, and publishing a medical journal.
What is the role of clinical pathologists?
When the Journal was founded, the discipline of Pathology was divided into Experimental Pathology, which focused on research, and Clinical Pathology, which focused on diagnostic approaches to patient care. This included examination of tissues, analysis of blood and body fluids, and other aspects of laboratory medicine. Through time, examination of tissue specimens became known as Surgical Pathology in the United States and Histopathology elsewhere. The term Clinical Pathology was given to the several disciplines that are part of laboratory medicine: medical microbiology, clinical (bio)chemistry, transfusion medicine, and so forth. Today, clinical pathologists oversee the diagnostic laboratories in hospitals and clinics. It is an increasingly important role, as up to 70% of the information contained in modern health records is generated in clinical laboratories.
Can you describe the American Journal of Clinical Pathology to those readers who are not familiar with it?
AJCP is one of the oldest pathology journals in the world. As the title suggests, our primary role is to publish articles in the discipline known as either clinical pathology or laboratory medicine. We also publish articles in the discipline known as anatomic or cellular pathology, particularly in the area of hematopathology. As such, we are one of the few truly general pathology journals, as opposed to the many journals with a topic focus restricted to a single subspecialty.
Who do you think should be reading about new clinical pathology research?
Academic pathologists as well as those in other settings, such as private practice, industry, government, and management should all be seeking out new research. Because pathology is integral to patient care, and increasing access to health care services is a global effort, we increasingly target pathologists working in low- and middle-income countries. Students and trainees, particularly pathology residents, should also look to stay up-to-date regarding new findings in their field.
Because you publish articles on many topics, and AJCP has a diverse group of readers, what are your priorities for publishing articles?
This is probably our greatest challenge. We publish manuscripts with the best quality and scientific validity, but we must balance this against our goal of publishing articles from many disciplines, and increasingly those submitted from around the world where many physicians and scientists do not have access to the same resources that we have in the United States and Canada. We also make an effort to publish manuscripts from pathologists and laboratory scientists who are early in their careers. As a result, our published articles represent our topical content and our readership. Our Editorial Board spends a lot of time thinking about this.
Does that emphasis on publishing manuscripts from authors who may not be as experienced in publishing lead to any other challenges?
Not as many as one might think. We do end up sending a number of manuscripts back for further revisions and make more extensive suggestions to authors, but overall the authors are quite receptive and clearly learn from the experience. Since I began my tenure as Editor we have processed several thousand manuscripts and there have been fewer than five authors who presented difficult challenges for us. That is a credit to the authors we have worked with.
What is it like being the Editor of a journal that is sponsored by a professional society as opposed to one that is fully independent?
Our sponsoring organization, the American Society for Clinical Pathology (ASCP), is one of the oldest and largest professional medical societies in the United States. Moreover, it has an outstanding track record in publishing both journals and textbooks, so publishing is fully part of the organizational culture. ASCP has always had leadership that understands the role of publishing in patient care, education, training, and research. ASCP leadership and the Board of Directors work hard to make certain that all parts of the organization are aligned and that the collective efforts are effective in fulfilling our mission. Some readers have asked if the journals are fully independent in terms of editorial functions and content, and the answer is firmly “yes”—everyone in the organization understands and supports the need for editorial independence. It’s a rewarding environment to work in.
How do you see the discipline of clinical pathology and associated research evolving in the future?
As populations around the world begin to demand better access to high-quality health care, there is going to be a marked increase in the need for affordable diagnostics. In addition, there will be a need for diagnostic technology that is more robust and durable, not as susceptible to climatic conditions such as heat and humidity, and requires less technical expertise to maintain and use. The role of clinical pathologists will be to compare and contrast competing technologies and determine which, if any, provide the diagnostic information needed for patient care in a given setting.
With your emphasis on global health, what changes do you foresee in publishing a medical journal?
The role of medical journals has been fairly constant over the decades, mostly one of publishing results of research efforts to further knowledge, publishing review articles to keep the readers up to date, and providing opportunities for physicians and scientists to share their knowledge. Those roles will continue, but medical journals will need to expand their role in educating the public, in advocacy, and in guiding public policy. Put another way, they need to be able to present their content to a much broader audience and, as part of that, explain why their articles are important and how the findings relate to the broader world. A few journals have done this for many years, but more journals need to do so. Otherwise they will become irrelevant to all but a small audience, and small audiences tend not to have much global impact.
Featured image credit: Laboratory by DarkoStonjanovic. CC0 Public Domain via Pixabay.
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