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The pathologist in the 21st century—generalist or specialist?
  1. Nigel Kirkham1
  1. 1Department of Histopathology, Royal Sussex County Hospital, Brighton BN2 5BE, UK
  1. Dr Kirkham email: nigelk{at}

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A jack of all trades and master of none?

Virchow and his fellow pioneers were active in the 19th century, but pathologists are largely a creation of the 20th century and have really only been present in numbers in the second half of the century. In the United Kingdom the development of the National Health Service over this period has seen the development and expansion of hospital laboratories. This development process has been one of successive waves of specialisation.

The first consultant that I worked for had started his consultant career as a single handed general pathologist, covering all aspects of pathology in what was, for the time, quite a large district hospital. He began with a skeleton staff and by the time of his retirement was working in a laboratory that had expanded to have consultants in histopathology, haematology, and microbiology, and a senior biochemist in the chemical pathology department. In the ensuing years that laboratory has closed as a result of rationalisation and amalgamation of services. The histopathology and cytopathology services are now provided as part of the work of a larger group of consultants whose work comes from several hospitals and who are each specialised, working only in one or a small group of subspecialist areas.

The move from generalist to specialist has been far quicker in the clinical specialties, which were fewer in number 50 years ago. The general surgeon and the general physician held sway in the general hospital. The demands of increasing complexity of diagnosis and treatment combined with increasing expectations from patients and their relatives have led to considerable changes, some driven by technological advances and others by new treatments or by different approaches to the patient.

Perhaps the most important technological changes we have seen in the last 25 years have been …

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