article 1 touches on key issues for the future of pathology. I would like to share with the Cancer readership and with my colleagues the direction I have taken with my department at Lehigh Valley Hospital. We are the largest acute care hospital in Pennsylvania and among the top 10 hospitals in the country in our level of intensity of service. As such, we are a heavily specialized and subspecialized institution. My Department of Pathology has evolved into a subspecialized department. The specimens are shunted each day to "pods" of subspecialists. The gastroenterologists and colorectal surgeons are in constant communication with the gastrointestinal pathologists, who are very much a part of the decision-making team. Gynecologic pathology and gynecologic cytopathology actually share appointments in the Department of Gynecology. They are an integral part of the resident education program in gynecology and conduct multiple weekly multidisciplinary patient care seminars (i.e., a cytopathcolposcopic care seminar). The subspecialty model provides not only daily but hour-by-hour clinical interaction with the pathologists. The results have had an enormously positive impact on patient outcomes. Care managers understand outcome enhancement and are anxious to support these activities, which in the final analysis are important in cost reduction.
Our gynecologists understand that cervical cytopathology reflects a continuum of change in the evolution of a disease process and that "snapshot" cytopathologic evaluations do not serve the patient well. The gynecologic pathologists and gynecologic cytopathologists provide an interpretation of a continuum of changes in the evolution of a disease process closely correlated with colposcopic data and histopathologic changes that prompt essential interventions but most importantly prevent unnecessary interventions. The cheap "snapshot" cytopathology reporting leads to extremely expensive, potentially dangerous, unnecessary intervention with alarming frequency. Our collaboration and our sharing of responsibility encourages the attending staff to intervene in a more prudent and conservative fashion, and we have produced significant data on the cost savings achieved by avoidance of unnecessary procedures, while also demonstrating improved outcomes for our patients. This type of involvement not only ensures but enhances the pathologist's roll as a medical consultant. At the front end of the service, we are not the "low cost provider"; but in the overall cost of care, we have provided enormous savings to the system. We have been rewarded by our volume of gynecologic cytopathology, which has grown by 300% over the past 5 years.
Another directive is in the enhancement of information capability. We are extremely anxious to produce a patient-oriented 43 CANCER CYTOPATHOLOGY