To the Editor: We read with great interest the article by Gutmann describing the situation that people have little interest in pathologists and their vocation. To estimate public perceptions of pathologists among Japanese lay people, we carried out a questionnaire survey.

We employed the questionnaire in face-to-face interviews in downtown Sapporo, Japan, on the 26th and 27th of October 1997. The questionnaire was designed to be comprehensible and avoid leading questions. Two of the eight items were questions about the respondent's attributes, four were throwaway questions, and two were key questions. We did not mention the purpose of this survey, and it was introduced as “a survey of the public awareness of the early detection of gastric cancer” because we did not wish to bias the responses to the key questions. For the same reason, we did not use the word pathologist (byori-i, in Japanese), except in the last question.

The 203 respondents all were of Japanese nationality aged 18 years or more. Eighty-nine were male, and 114 were female. All respondents seemed to understand what each question asked. One of the key questions was, “Have you heard of the word pathologist?“ and it was the last question of the questionnaire. There were 77 (38%) affirmative answers and 126 (62%) negative ones. This proportion was not affected by sex or age group (P =.825 and .182, respectively).

The second key question was, “When you are undergoing gastroscopy, the physician may decide to take a small specimen from your stomach for examination under a microscope. Who really carries out the microscopic examination and makes the final diagnosis?” Four answers were prepared, and respondents were asked to choose one of them: (1) the physician performing the gastroscopy, (2) a physician not performing the gastroscopy who has been trained in cancer research, (3) a medical technician trained in microscopic examination, (4) and a medical doctor specially trained in microscopic examination. The last one clearly implied “pathologist.” Fifty-five (27%) answered pathologist, and 121 (60%) answered “physicians” (combined physicians A and B; Table 1). The proportion of respondents who chose pathologist decreased with age (P =.015) and was not affected by sex or the experience of gastroscopy (P =.633 and .404, respectively). Respondents who had heard of the word pathologist tended to choose pathologist in this question (P =.0308), whereas 45% of them chose physicians.

TABLE 1 Answers to the Question, “Who Makes the Microscopic Diagnosis?”
Full size table

The present study shows that the public perception of pathologists in Japanese lay people is insufficient. In Japan, the mass screening for gastric cancer by radiography or gastroscopy is performed nationwide. Half of the respondents to our questionnaire had experienced gastroscopy. Nevertheless, the experience of gastroscopy did not cause them to recognize pathologists. The present research did not clarify the reasons that pathologists remain anonymous during cancer diagnosis. It is possible that some lay people do not notice the existence of not only pathologists but also the microscopic examination per se.

It was recently reported that microscopic criteria for gastric carcinoma differ between Japanese and Western pathologists (1). Japanese criteria tend to produce a more aggressive diagnosis.

We speculate that the fact that lay people are apathetic about pathologists and their work may make it easier for pathologists to select the aggressive diagnosis in debatable cases.