Friday, February 23, 2018

23 February 2018: Updated image policy

Our updated image policy is to rely almost exclusively on images contributed by Authors, our Editorial Board or pathologist contributors. This minimizes bad links because these images are stored on our server. We will also use some images contributed by "preferred sites", including free full text journals, Wikipedia, Webpath, Pathopic, governmental institutions and medical institutions. We are removing Nature links, because they continue to block our website despite our attempts to change this.

If there is a link that you object to for copyright or other reasons, please contact Dr. Pernick directly at and we will take the appropriate action. We do not copy images, except for thumbnails with permission. We do not violate copyright laws, and we respond to copyright "shake downs" (demands for payment for linking to images) by reporting the perpetrator to the appropriate authorities (attorney general, local police, Better Business Bureau, attorney grievance board).

Friday, February 16, 2018

16 February 2018: Follow us on Instagram!

We are now active on Instagram @pathoutlines. We will post interesting cases there.

Thursday, February 15, 2018

15 February 2018: Changes regarding Images

In response to users, we are advising Authors to contribute their own images, or those from others who give permission, so they can be posted on our server. These images will not disappear over time. As a result, users will gradually see reductions in images from other websites and fewer bad image links. Even if you are not an author, we welcome you to contribute high quality images of topics not well represented on our website, whether micro, gross, IHC, molecular, EM or clinical. They should be sent as attachments to, with a figure legend. Please also indicate the name and institution of the contributor(s).

15 February 2018: New CME page

Our CME page has a cleaner look, and now has 63 offerings. You can search for CME by subspecialty, by organization, by date posted as well as by expiration date (so sign up for CME courses that expire soon).

15 February 2018: 2017 Jobs Summary

We have now posted the 2017 Summary of our Jobs Report. Click here to view the report. It is also accessible from the Jobs page by clicking on the orange link.  It begins:

For calendar year 2017, there were 660 job postings for full time or part time pathologists at, which form the basis for the statistics below. This is a 15.8% increase from the 570 ads posted in 2016 (see 2016 Jobs Summary). We have excluded postings that were only for locum, Ph.D., residency, fellowship or non-pathologist positions. Of these postings, 614 were for 1 position, 21 were for 2 positions, 2 were for 3 positions, 22 were for an unspecified number of positions greater than 1 and and 1 was for an unspecified number of positions greater than 3.

Wednesday, February 7, 2018

7 February 2018: Textbook Updates

We have posted updated reviews of the following topics:

7 February 2018: New Payment page and other changes

We now have a separate Payment page, distinct from the Advertise page (they were together). The Advertise page will give more information about banner and email advertising. Also, the Amazon link on the top line of the banner was removed (it is still in the footer), and we moved Contact us from the bottom of the header to the top of the header (to make room for the payment link).
Let us know if you have any questions.

Tuesday, February 6, 2018

6 February 2018: We demand Vicodin; the Germans accept Ibuprofen

Great article sent to me:

We demand Vicodin; the Germans accept Ibuprofen

Whenever someone touts the much less expensive healthcare systems outside the US, and suggests that we adopt a single payer system, I remember the experience we had with our son James in Florence Italy at the best children's hospital in the country. He was hospitalized for a condition that, fortunately, was not life-threatening, but we followed the advice of the doctors to keep him there overnight.
I was with him, and we were in a bare-bones semi-private room, not a private room, and we had very little nursing support during the night, in comparison with an American hospital. He received excellent care, but there were no amenities of the kind we are used to having in a US hospital. We noticed a similar pattern in Switzerland, when one of our executives broke his leg on the ski slopes and was airlifted to the hospital for emergency surgery. The surgery was done flawlessly, but he was kept in the hospital for two weeks, and had almost no amenities.
With that in mind, I was most interested in the first-person narrative of an author named Firoozeh Dumas in the Sunday, January 27, 2018, issue of the New York Times, entitled "After Surgery in Germany, I Wanted Vicodin, Not Herbal Tea." The author described a major surgery she had in Munich, more specifically, the very different practices of German surgeons relative to pain management, after surgery. In contrast to what she had come to expect in the US, the German surgeon initially told her she would not get a prescription pain killer, but would get Ibuprofen.
More revealing was his comment, which the author paraphrased and translated; "Pain is a part of life. The pain will guide you....If I give you Vicodin, you will no longer feel the pain, yes, but you will no longer know what your body is telling you....And please be careful with Ibuprofen. It's not good for your kidneys. Only take it if you must. Your body will heal itself with rest."
Imagine an American hospital confronted with the same kind of request from a patient. Our doctors do more, and are far more accommodating to patients. They are also graded by Medicare on patient satisfaction with their attentiveness to patient complaints of pain. The scenario this author describes probably would be very unlikely in an American surgical setting. Similarly, she asked for stool softeners, but the surgeon directed her to sip coffee slowly and have the coffee serve as a laxative.
The reason this story is worth retelling is that anyone who believes that we can replicate the lower costs of healthcare by importing a single-payer model from another country is failing to take into account some of the attributes of our healthcare delivery system that we take for granted, but that are not standard practice outside the United States. As a general rule, we are far more impatient and intolerant of pain or of delays in getting care for medical conditions that give us discomfort. In fact, many Medicare patients end up going to the emergency department for a non-urgent and relatively minor problem if they wake up with it, because they do not want to wait for the doctor's office or the urgent care clinic to open at 9 am.
Our impatience is deeply imbedded in our culture in large and small ways. I spent 10 days in Ottawa with my son James at a chess tournament and went to the one coffee shop open at 7 am every day, the Tim Horton's. At the Starbucks where I live, there are two cashiers and almost no one waits more than two minutes to have an order taken by a barista. At the Tim Horton's, we were 18th in line and there was one cash register being used. Everyone patiently waited 20-30 minutes to get served.
This "quick fix" mentality is more prevalent in America than anywhere else, with the possible exception of China. The lower-cost, higher-quality developed country healthcare systems in countries like Germany, Italy, the UK, Switzerland, Canada, and the Netherlands work, in large part, because these countries focus on delivering necessary care through primary care physicians, not elaborately gold-plated care that dazzles patients, but is over and above what a patient needs.
In fact, I would argue that the German surgeon may have a better case for his point of view than the American physician who quickly gives the patient a prescription for a medication that masks pain. I visited with a great podiatrist named David Armstrong from Arizona who referred to the devastating effect of diabetes in depriving patients of "the gift of pain."
There is no right answer, but there are very clear cultural differences that make the adoption of a single-payer system less likely to achieve the results it achieves elsewhere if used in the United States.

Monday, February 5, 2018

5 February 2018: Welcome Dr. Clay to our Editorial Board

We are happy to welcome Dr. Michael Clay, M.D., to our Editorial Board. Dr. Clay is currently on staff at St. Jude Children's Research Hospital in Tennessee. He will be our Editor for soft tissue, molecular and pediatric pathology topics. Welcome to the Editorial Board, Dr. Clay.

Friday, February 2, 2018

1 February 2018: Record Jobs, Fellowships and Page Views

January 2018 was a busy month at with a record 90 job postings and 31 fellowship ads. We also had record numbers of page views to our Jobs page (57,077) and overall website (2,061,665).

We appreciate our advertisers, who enable us to provide this labor intensive resource to the pathology community.

Thursday, February 1, 2018

1 February 2018: View prior Jobs, Fellowships and Conferences pages

We have now posted versions of the Jobs, Fellowships, and Conferences pages as of December 1, 2017, January 3, 2018 and February 1, 2018. We have them posted as far back as January 2012.

If you need to look up a prior ad, we maintain these files as of the first of each month (or close to it). See files below:

As of December 1, 2017: Jobs, Fellowships, Conferences 

As of January 3, 2018: Jobs, Fellowships, Conferences 

As of February 1, 2018: Jobs, Fellowships, Conferences 

The format is the name of the file, plus yyyymm, where yyyy is the year and mm is the month.  So, for example, jobs posted as of April 1, 2016 are at
Please contact us with any questions via email at or telephone at (248) 646-0325.