Document Type : Original Article

Authors

1 Research Center of Quran, Hadith and Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran

2  Department of Pathology, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran

4 Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

5 School of Medicine and Health Sciences, Tecnologico de Monterrey, Monterrey, Mexico

6 Department of Pathology, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

For a successful treatment process, the medical team members must be in good physical and mental 
condition. Pathologists are one of the main modern medicine members that should be consulted 
in all stages of the treatment procedure. Sixty‑six percent of clinical decisions are made based on
in vitro diagnosis. Burnout is defined as chronic uncontrolled occupational stress. Burnout has a 
massive impact on patient safety, quality of treatment, and reduced patient satisfaction. Physician 
satisfaction with his job affects patient satisfaction and the quality of medical services provided. The 
most influential factors on quality of life were exercise and physical activity, having leisure time, and 
not smoking. In different aspects of lifestyle, physicians have scored lower on their physical activity 
index. One of the most critical pillars of human life is their religiosity. The presence of religious beliefs 
among physicians is strong. Workload and increased responsibilities are the most effective factors 
on pathologists’ stress. Pathology creates a bridge between basic sciences and clinical sciences. 
Therefore, promoting pathology education leads to training better physicians. The purpose of 
compiling this Narrative review is to clarify the issues raised in various aspects of pathologists’ lives 
and provide solutions to improve each of them. There are several solutions to the problems raised in 
this article: Increasing salaries, improving working conditions, creating a better view of pathologists 
by avoiding isolation and being more active and visible, and paying attention to medical education. 
We recommend that researchers review issues in other medical specialties to provide accurate and 
concise information to physicians and policymakers.

Keywords

1. Schrijver I. Pathology in the medical profession? Taking the 
pulse of physician wellness and burnout. Arch Pathol Lab Med 
2016;140:976‑82.
2. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: A missing 
quality indicator. Lancet 2009;374:1714‑21.
3. Robboy SJ, Gupta S, Crawford JM, Cohen MB, Karcher DS, 
Leonard DG, et al. The Pathologist Workforce in the United States: 
II. An interactive modeling tool for analyzing future qualitative 
and quantitative staffing demands for services. Arch Pathol Lab 
Med 2015;139:1413‑30.
4. DyrbyeLN, VarkeyP, Boone SL, SateleDV, Sloan JA, Shanafelt TD. 
Physician satisfaction and burnout at different career stages. Mayo 
Clin Proc 2013;88:1358‑67.
5. Garcia E, Kundu I, Kelly M, Soles R, Mulder L, Talmon GA. 
The American Society for clinical pathology’s job satisfaction, 
well‑being, and burnout survey of pathologists. Am J Clin Pathol 
2020;153:435‑48.
6. Misialek MJ. Valuing value: The changing role of pathologists. 
Am J Clin Pathol 2014;142:584‑5.
7. Rohr UP, Binder C, Dieterle T, Giusti F, Messina CG, Toerien E, 
et al. The value of in vitro diagnostic testing in medical practice: 
A status report. PLoS One 2016;11:e0149856.
8. Kirkham N. The pathologist in the 21st century – Generalist or 
specialist? J Clin Pathol 2000;53:7‑9.
9. Watts JC. Is there still a need for the general surgical pathologist? 
Am J Clin Pathol 1996;106 4 Suppl 1:S74‑6.
10. Conant JL, Gibson PC, Bunn J, Ambaye AB. Transition to 
subspecialty sign‑out at an academic institution and its 
advantages. Acad Pathol 2017;4:2374289517714767.
11. Mousavi SM, Hashemi SA, Parvin N, Gholami A, Ramakrishna S, 
Omidifar N, et al. Recent biotechnological approaches for 
treatment of novel COVID‑19: From bench to clinical trial. Drug 
Metab Rev 2021;53:141‑70.
12. Bagheri Lankarani K, Honarvar B, Omidifar N, Pakdin M, 
MoghadamiM, ShokripourM, et al. Prevalence of anti‑SARS‑CoV‑2 
antibody in hospital staff in double‑center setting: A preliminary 
report of a cohort study from Iran. Shiraz E Med J 2021;22:e112681.
13. Hashemi SA, Golab Behbahan NG, Bahrani S, Mousavi SM, 
Gholami A, Ramakrishna S, et al. Ultra‑sensitive viral glycoprotein 
detection NanoSystem toward accurate tracing SARS‑CoV‑2 
in biological/non‑biological media. Biosens Bioelectron 
2021;171:112731.
14. Shahnazi H, Daniali SS, Sharifirad G. Job satisfaction survey 
among health centers staff. J Educ Health Promot 2014;3:35.
15. Pehlivanoglu B, Hassoy H, Gul G, Aykutlu U, Doganavsargil B. 
How does it feel to be a pathologist in turkey? Results of a survey 
on job satisfaction and perception of pathology. Turk Patoloji Derg 
2021;37:39‑50.
16. Linzer M, Poplau S, Babbott S, Collins T, Guzman‑Corrales L, 
Menk J, et al. Worklife and wellness in academic general internal 
medicine: Results from a national survey. J Gen Intern Med 
2016;31:1004‑10.
17. The Lancet. ICD‑11. Lancet 2019;393:2275.
18. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, 
et al. Burnout and satisfaction with work‑life balance among US 
physicians relative to the general US population. Arch Intern Med 2012;172:1377‑85.
19. Yates SW. Physician stress and burnout. Am J Med 2020;133:160‑4.
20. Shanafelt TD, West CP, Sloan JA, Novotny PJ, Poland GA, 
Menaker R, et al. Career fit and burnout among academic faculty. 
Arch Intern Med 2009;169:990‑5.
21. Koval KLMML. Medscape Pathologist Lifestyle, Happiness & 
Burnout Report; 2021. Available form: https://www.medscape.
com/slideshow/2021‑lifestyle‑pathologist‑6013519. Accessed 24 
February 2021.
22. Leslie Kane M. Medscape National Physician Burnout, Depression 
& Suicide Report; 2019. Available form: https://www.medscape.
com/2019‑lifestyle‑burnout. Accessed 24 February 2021.
23. Panagioti M, Geraghty K, Johnson J, Zhou A, Panagopoulou E, 
Chew‑Graham C, et al. Association between physician burnout 
and patient safety, professionalism, and patient satisfaction: 
A systematic review and meta‑analysis. JAMA Intern Med 
2018;178:1317‑31.
24. World Health Organization – WHO. A Glossary of Terms 
for Community Health Care and Services for Older Persons. 
Vol. 5. WHO Centre for Health Development (Kobe, Japan): 
World Health Organization; 2004. p. 37.
25. Rodriguez Añez CR, Reis RS, Petroski EL. Brazilian version of 
a lifestyle questionnaire: Translation and validation for young 
adults. Arq Bras Cardiol 2008;91:92‑8.
26. Torres AR, Ruiz T, Müller SS, Lima MC. Quality of life, physical 
and mental health of physicians: A self‑evaluation by graduates 
from the Botucatu Medical School – UNESP. Rev Bras Epidemiol 
2011;14:264‑75.
27. Seib C, Whiteside E, Humphreys J, Lee K, Thomas P, Chopin L, 
et al. A longitudinal study of the impact of chronic psychological 
stress on health‑related quality of life and clinical biomarkers: 
Protocol for the Australian Healthy Aging of Women Study. BMC 
Public Health 2014;14:9.
28. Sens GR, Abdala GA, Meira MD, Bueno S, Koenig HG. Religiosity 
and physician lifestyle from a family health strategy. J Relig 
Health 2019;58:628‑38.
29. Jiang Y, Da W, Qiao S, Zhang Q, Li X, Ivey G, et al. Basal cortisol, 
cortisol reactivity, and telomere length: A systematic review and 
meta‑analysis. Psychoneuroendocrinology 2019;103:163‑72.
30. Mehrsafar AH, Serrano Rosa MA, Moghadam Zadeh A, 
Gazerani P. Stress, professional lifestyle, and telomere biology 
in elite athletes: A growing trend in psychophysiology of sport. 
Front Psychol 2020;11:567214.
31. (OHRP) OfHRP. The Belmont Report Ethical Principles 
and Guidelines for the Protection of Human Subjects of 
Research. Available from: https://www.hhs.gov/ohrp/
regulations‑and‑policy/belmont‑report/read‑the‑belmont‑report 
/index.html. [Last updated on 2018 Jan 15].
32. Bhagwat S, Pai SA. Medical ethics in laboratory medicine: 
A review, with an oath for pathologists. Indian J Med Ethics 
2020;V: 39‑44.
33. Wijeratne N, Benatar SR. Ethical issues in laboratory medicine. 
J Clin Pathol 2010;63:97‑8.
34. Stempsey WE. The virtuous pathologist. An ethical basis for 
laboratory medicine. Am J Clin Pathol 1989;91:730‑8.
35. Gronowski AM, Budelier MM, Campbell SM. Ethics for laboratory 
medicine. Clin Chem 2019;65:1497‑507.
36. Allen MJ, Powers ML, Gronowski KS, Gronowski AM. Human 
tissue ownership and use in research: What laboratorians and 
researchers should know. Clin Chem 2010;56:1675‑82.
37. Furness PN, Nicholson ML. Obtaining explicit consent for the 
use of archival tissue samples: Practical issues. J Med Ethics 
2004;30:561‑4.
38. Savulescu J. No consent should be needed for using leftover body 
material for scientific purposes. Against. BMJ 2002;325:648‑51.
39. Kumar V, Abbas AK, Aster JC. Robbins Basic Pathology 
E‑Book. Amsterdam: Elsevier Health Sciences; 2017.
40. Saxena R, Saxena A, Chandra M, Saxena R. Role of pathologist as 
an educator in lifestyle medicine in era of molecular diagnostics. 
Am J Clin Pathol 2018;150 Suppl 1:S85‑6.
41. Shahedi F, Ahmadi J, Sharifi T, Seyedhasani SN, Abdollahi M, 
Shaabani N, et al. A new method of “student‑centered formative 
assessment” and improving students’ performance: An effort 
in the health promotion of community. J Educ Health Promot 
2020;9:136.
42. Steger B, Colvin HP, RiederJ. Scientific activity and working hours 
of physicians in university hospitals: Results from the Innsbruck 
and Salzburg physician lifestyle assessment (TISPLA). Wien Klin 
Wochenschr 2009;121:685‑9.
43. Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable 
lifestyle on recent trends in specialty choice by US medical 
students. JAMA 2003;290:1173‑8.
44. Albores‑Saavedra J. On being a pathologist: A brief chronicle of 
an academic surgical pathologist. Hum Pathol 2012;43:1533‑7.
45. Niconchuk JA, Hyman SA. Physician burnout: Achieving wellness 
for providers and patients. Curr Anesthesiol Rep 10, 227232 
(2020):1‑6.
46. WHO. Consolidated Guidelines on HIV Testing Services. 5Cs: 
Consent, Confidentiality, Counselling, Correct Results and 
Connection December 2016. Available form: https://www.who.
int/hiv/pub/vct/hiv‑self‑testing‑guidelines/en/. Accessed 29 
February 2021.
47. Harrold IM, Bean SM, Williams NC. Emerging from the basement: 
The visible pathologist. Arch Pathol Lab Med 2019;143:917‑8.