To the Editor:
I have been a diagnostic surgical pathologist for almost a quarter of a century. Recently I took up birdwatching (or birding, for short) as a hobby. Right away I was struck by the similarities in the two disciplines.
For those of you unfamiliar with birding, it is the fastest-growing hobby among Americans, and has long been highly popular in other countries. Fanatic `birders' have been known to brave storm and blizzard, even risk getting arrested for trespassing, all to glimpse 1 rare species of gnatcatcher. It is the least invasive of all sports and gets one off the couch, hiking, and taking in the countryside with a binocular in one hand and a bird book in the other. Well...there are worse things in life I suppose.
Diagnostic pathology (general surgical pathology, cytology, or dermatopathology) is highly visual. We all are trained to detect the slightest visual variation from the `normal' background, immediately zero in on it with higher magnifications, and start mentally ticking off the various diagnostic possibilities until we are left with one that fits all the criteria—clinical, gross, and microscopic. Often this process is subconscious in routine, easy cases; in difficult cases, we go through the same processes, but with the help of reference books, special procedures, and expert opinions (Table 1).
One uses exactly the same mental algorithms in `diagnosing' (read `identifying') a bird in the wild. While scanning a dense thicket, the slightest movement or an odd silhouette alert one of the presence of a bird. Once noticed, the eye and the brain rapidly process the primary (read `low-power') visual clues of size, shape, and color of the bird. A mental differential diagnosis list begins to form. Further examination with the binoculars (read `high-power') shows the details of the eye ring and shape of the beak or the stripe on the wings. These help narrow the list further until there are 2 or 3 possibilities left. Checking on the background information (read `clinical history') of season, calls, and geographic habitat is usually sufficient to confirm the identification (read `diagnosis') of the bird. And all this must be done fast, before the bird flies away! For the beginners, comparing the features with the pictures in a guidebook is essential. One rifles through it much the same way one flips through a color atlas of dermatopathology, trying to match the features of an odd sweat gland tumor. In difficult cases, seeking `expert opinion' helps in both cases.
Of course birding is not a billable activity. There is no ICD-9 code for any bird. But there is also none of the fear of penalty for a wrong diagnosis either. In short, birding has all the fun and none of the hassles of a purely intellectual pursuit.
Perhaps we should encourage our students and residents to pursue this hobby. It will not only get them out of their desks into the fresh air but also might sharpen their diagnostic skills.
Chhanda Bewtra, MD