5 Questions: What's It Like to Work in Pathology?

By Vivian Mason

Retired Navy Captain (Dr.) Barbara Knollmann-Ritschel
Retired Navy Captain (Dr.) Barbara Knollmann-Ritschel is the
Vice Chair of Pathology Education and Professor of Pathology
and Emerging Infectious Diseases at USU. (Photo credit: Tom
Balfour, USU)
Physician: Retired Navy Captain (Dr.) Barbara Knollmann-Ritschel 

Department: Pathology

Title: Vice Chair of Pathology Education and Professor of Pathology and Emerging Infectious Diseases, F. Edward H├ębert School of Medicine, Uniformed Services University (USU)    

Years in Pathology: 22   

Specific interests in Pathology:  Cytopathology - I am fascinated by small changes in the cells that lead us to very different diagnoses. Aspirations - I really liked being at the patient's bedside doing the aspirations! Molecular Pathology - In the last years molecular pathology has really taken off and I find it amazing how many new molecular changes we can identify that change treatment and ultimate outcome for patients.

Qualities of a Pathologist: Good written and verbal communication skills are essential for a pathologist! Good teachers, as we teach all the time. Clear communication is a key and important patient safety item. If a physician can’t understand a diagnosis we make, it is no good for the patient.

Influential Mentors: Dr. Michael Henry my Program Director, Drs. Jeffrey Ogorzolak, Bill Laskin, Jeanne Rushin, and John Williams as staff pathologists, and Dr. Richard Conran who mentored me into Academic Pathology. Nationally, I would need to include Drs. Karen Kaul and Jim Crawford who are fabulous role models.  But honestly, I also need to include our students.  Our students really help us to grow as educators and help us improve our teaching skills every day!

Sources of Inspiration: My parents. My mother was a microbiologist and my father a pharmacologist and physician. They really inspired me into medicine. I would also need to include my kids who are both very curious and would ask a million questions as they sat on my lap when they were little and I was trying to prepare for a presentation. They made me think more about the disease and answer the "why" question! And lastly, our patients who we strive to give the best and most accurate diagnosis each day. Serving our patients is why we are physicians.

Favorite Motivational Quote: “What does God want me to do today?”  

Residency Nickname: “Queen of Aspergillus” (because I always ended up with interesting fungal cases) 

Q. Why did you choose pathology?

A. That’s a funny story. I went to medical school wanting to be a surgeon. I really wanted to work with my hands. I used to sew clothes and that’s how I paid my way through college. In medical school, I had an HPSP scholarship and wanted to do one rotation in San Diego so I could meet up with my brother. So, I called about doing a surgery rotation, but was told there was no spot available. I asked about medicine, but got the same response. Then, I asked about pulmonary, but there was nothing available there, either. I was told that there was only one opening left for rotations and that was in pathology. It was the only opening that coincided with the particular month that my medical school allowed me to do the rotation. So, I said, “I’ll take it because I can do anything for a month!” I have never regretted that decision.

Q. What do you especially like about pathology?

A. Pathology touches everything in medicine and affects all aspects of medical care. About 70% to 80% of all medical decisions are based on laboratory testing. Pathologists are in charge of the clinical lab, and they do the detective work in anatomic pathology. 

A friend of mine who’s an OB/GYN surgeon says she always tells her patients that, “It’s a lesion until the pathologist tells us what it is.” So, it’s the pathologist who makes the decision of whether a tumor is benign or malignant, determines if it is completely resected, and dictates the next step in patient care based on the diagnosis. 

In addition, molecular testing for personalized medicine is done in the pathology lab. We engage in making the diagnostic decisions and directing further patient care behind the scenes. We’re the quiet ones in the back. No one ever knows the name of their pathologist. But day by day and case by case, we explore the human body by investigating the clues we see in tissue or blood. It’s just fascinating to put it all together.

Q. How did you come to USU?

A. After leading the pathology lab in Charleston, South Carolina, I came back to the Bethesda area in 2005. I had applied to be Residency Program Director at the National Naval Medical Center, but Dr. Richard Conran, head of the search committee and in charge of the pathology curriculum at USU, wanted me to come work for him. I had enjoyed working with Dr. Conran when I was a resident and had admired his teaching skills. He convinced me that USU was the best opportunity for me to grow in academic pathology and that it was the best fit for me work/life balance-wise with two children. So, I came to USU. 

There is a stack of books and two students looking through the stack. "Atlas of Pathology" is a title seen prominently on a pink book.
“I think it is a very exciting time to be in pathology and medicine in general, and molecular pathology is a growing interest now.” - ret. Capt. (Dr.)
Barbara Knollmann-Ritschel, Vice Chair of Pathology Education, USU (Photo credit: USU Photo)

Q. What do you do in your role as pathologist at USU?

A. I’m a Jill of all trades. My primary job is to run pathology education at USU. I put a ton of effort into this because I think that pathology is really the foundation of medicine―the study of disease. About 50% of the USMLE Step 1 exam is pathology; so, it’s essential that our students have a solid foundation in pathology. 

I strongly feel that we have to have the best education possible for our students. In holding positions on national committees, especially for undergraduate medical education in pathology, it’s helpful because it allows us to keep the curriculum ahead of the curve. We’re among the first to make the changes to incorporate new concepts into teaching. I have a great team helping to ensure that we meet the standard for our students. 

In addition, I do research. I inherited the research lab of the late Dr. Radha Maheshwari. Over the past years, students have graduated, and young scientists have moved on to bigger jobs. It’s rewarding to watch lab members grow and flourish. I’m honored to continue the military-relevant research in traumatic brain injury with Dr. Manish Bhomia and radiation protection research with Dr. Maureen Hood, which are essential for the military. 

Another part of my role in pathology is clinical care supporting the Walter Reed pathology department, the residency program, and pathology in the region. I always enjoy sitting at the microscope and looking at slides.

Q. What advice can you offer USU students who are considering this specialty?

A. I would say “go for it!” It’s a wonderful specialty with lots of opportunities. There are so many options in pathology that you can focus on, either surgical pathology, cytology, hematopathology, molecular pathology, or blood banking, among others. There are some areas with more or less direct patient contact. It’s a vastly changing and very important field. Nationally, pathologists are in short supply. Remember the old television show Quincy, M.E.? Well, that’s really the detective work that we do in anatomic pathology every day. We try to figure things out, while giving our best to every patient. I say to the residents, “Every glass slide of tissue I look at is a patient. It’s the patient’s tissue we’re looking at, not a number.” The day I don’t think of the slide as part of the patient is the day I stop practicing because the patient is essential.