To our knowledge, this study represents the first general health assessment of pathologists. The feedback rate of up to 65% is higher than that of most previous studies [2, 10, 38].
The prevalence of musculoskeletal problems among pathologists was high. It is interesting to note that these problems were also experienced by many young pathologists. This argues against a mere aging effect of this disorder, and also underlines the importance of addressing this problem not only on middle aged to older employees but in the younger ones, at an early stage in their career. Musculoskeletal disorders are common in the general public and constitute one of the major causes of work absenteeism in developed countries [39–41]. Female gender, higher age and low socioeconomic status are associated factors . The prevalence of upper extremity symptoms in working populations is estimated to be between 20%-30% . While increased working hours were associated with musculoskeletal problems, other factors such as working time at the microscope/computer or ergonomic workplace settings were not; this is in agreement with a study by Lorusso et al. . The lack of an association of ergonomic workplace settings with lower prevalence of musculoskeletal problems, at least in terms of the one-month prevalence, is surprising. A possible explanation could be that the ergonomic equipment may have been acquired secondary to musculoskeletal disorders. Thereby the negative selection of affected pathologists might have concealed any positive effects of the ergonomic devices. The finding that 62% to 67% of pathologists with musculoskeletal problems who switched from a conventional microscope or office chair to ergonomically optimized models reported a relief of their pain further supports this theory.
Visual refractive errors are more common in pathologists than in the general population, university students or other hospital workers [44–49]. It is possible that ametropic students may choose more likely to enter this discipline. On the other hand, the work of pathologists is associated with possibly eye-straining activities such as long lasting microscopy and computer work [50–53]. The aggravation of ametropia while working in pathology, experienced by 50% of participants, might be part of the normal time course of conventional myopia, yet it may also be associated with the continuous near-field work required .
The analysis of injuries among pathologists suggests that injuries with sharp and possibly infectious instruments (mainly knives and needles), are almost an integral part of a pathologists’ career. With about 83% of pathologists affected, these injuries constituted the most common harm in pathology. Cutting injuries were the predominant type of injury. The predominance of residents among the injured pathologists may be explained either by their lack of experience, the training situation or by the fact that, unlike consultants, residents are more at risk as they are typically deployed on a daily basis in macroscopic organ dissection or autopsies. The few pathologists who stated having never experienced an injury in their pathology career, were mainly experienced senior consultants. With 26% of the never-injured pathologists, the use of cut-resistant gloves in this group was twice as high as in those consultants who have had experienced injuries. Seven of the eight residents who reported no injury in their pathology career ≤1 year work experience. Only one of those residents reported not using cut-resistant gloves. However, given the perspective of around 4–5 years of further training, the chance for future injuries during the course of their residency should not be neglected. Recognising that the use of cut-resistant gloves was rare among elder pathologists and assuming that dexterity was not substantially different between generations of pathologists, the possibility of recall bias must taken into account when interpreting the 19 never-injured consultants. One of the elder pathologists rightly commented that some of the retrospective data should be taken “cum grano salis” (Latin: with a pinch of salt).
Cut-resistant gloves, worn between conventional vinyl gloves, can protect users from cutting injuries . Loss of sensitivity and dexterity are reasons for rejection of this protective measure [29–32, 55]. Splashes to mucous membranes, constituting the second most common type of injury, should be preventable by protective glasses or facemasks. This study did not analyse the availability or the use of such masks.
A total of 94% of those pathologists injured reported no lasting damage from these events. This finding might support the somewhat fatalistic behaviour of many consultants when rejecting cut-resistant gloves and accepting cutting injuries as an inconvenient but harmless requirement in pathology. Reports on infections resulting from such injuries are also very rare [21, 23, 24]. However the possibility of serious consequences exists, and the reduction of injuries in these high-risk fields should be given high importance.
While HBV vaccination of medical professionals is a standard precautionary measure in most developed countries, a recent study from Lithuania revealed an alarming rate of almost 90% of non-vaccinated medical staff members . Meanwhile hepatitis B immunisation levels among Swiss pathologists were high. Nonetheless, about 5% of pathologists, almost exclusively senior consultants, reported being insufficiently immunized.
Formalin is the most widely used fixative in Swiss pathology institutes (unpublished personal experience). The effects of formaldehyde on human health are not well understood, especially in terms of malignancies [13, 15, 57, 58]. Malignancies were very rare in Swiss pathologists. No brain tumours or lympho-haematopoietic malignancies – previously believed to be pathology-associated malignancies - were reported . Although these results argue against major carcinogenic effects of formaldehyde exposure in a pathology setting, some caution is warranted due to possible recall bias, selection bias and small numbers [59, 60].
Intolerance reactions to formalin were reported by 25% of pathologists but specific allergies against formalin as well as against latex are rare [10, 14]. Whether a complete abandonment of formaldehyde in pathology is reasonable and feasible will depend on further proof of adverse effects of formaldehyde, safety and economic feasibility of alternative agents and requirements of a future more molecular-based spectrum of analyses.
Smoking prevalence in Switzerland has been decreasing slowly for several years and was around 30% in 2010, with more men smokers than women . In 2007 and 2009 12% to 17% of Swiss primary care physicians were active smokers [62, 63]. The prevalence in Swiss pathologists is even lower (10%). Along with a possible trend for the desired response, the daily confrontation with fatal consequences of smoking in the morgue and in cancer diagnostics might present one possible explanation. Furthermore the smoking ban in several Swiss hospitals, bars and restaurants may also have promoted lower smoking rates.
Interestingly, burnout and depression were not rare among study participants. The burnout prevalence in other medical professions ranged from 4% to 40% depending on the degree of burnout [64–67]. In these studies high workload, more than 50 working hours per week and frequent interruptions were factors associated with burnout.
The association between work efficiency and burnout and as a trend with depression can be interpreted differently. While insufficiently organised work can be depressing, people suffering from burnout or depression might rate their surroundings, perspectives and also work efficiency as being even less satisfactory. Nonetheless, employee-centred workflow optimisation should be taken seriously, especially since almost half of pathologists were unable to finish their work within regular working hours. Nearly one third of pathologists considered the workflow in their institution to be inefficiently organised.
Tuberculosis is often considered a ‘pathologists’ disease’ and has been demonstrated to affect pathologists much more often than the general population and other professional medical groups [26, 28, 68, 69]. In comparison, the prevalence of a history of tuberculosis in our cohort was low (1.2%). The tuberculosis skin test is considered a good test for tuberculosis control. It is also interesting that in comparison to other Swiss study cohorts a high percentage of pathologists reported having a positive tuberculin skin test during their time in pathology [70–72]. Almost 80% of pathologists had a BCG vaccination during their lifetime. Six to 10% of positive skin tests are thought to be attributable to a previous BCG vaccination but after more than 10 years after the vaccination it should no longer be considered in the interpretation of a positive test result [73, 74]. According to these data, the vaccination could explain a positive skin test in 8–10 pathologists within this study. That the number is three times as high might reflect a high level of infection with tubercle bacilli, which might remain in the body in an inactive state. Therefore the notion that pathologists are at increased risk of tuberculosis infection cannot be ignored. This underlines the importance of routine precautionary measures such as effective respirator masks.
Another important finding of this study is that pathologists are generally very positive about their working atmosphere, personal work-related future perspectives and the future relevance of pathology as a medical discipline. Reasons for a positive rating of the future relevance of pathology included the relevance of pathology to medicine and especially for oncologic therapy planning, the individualisation of therapies with the need for very specific pathologic diagnoses and the future importance of molecular pathology to answer prognostic and predictive questions. Reasons for a decreasing relevance of pathology included performing fewer autopsies, the reduction of pathology in the curricula of medical students, the introduction of the DRG (diagnosis related groups) system in Switzerland and the fear that attractive diagnostic tests might be taken over by other medical disciplines.