3 Questions with Daniel Mettman, MD, FASCP

The continually changing nature and its impact on physician roles and responsibilities can be challenging for some, but for Daniel Mettman, MD, FASCP, pathologist in the Pathology and Laboratory Medicine Service at the Kansa City VA Medical Center, it’s an opportunity.

“I hope to contribute to the promotion of the pathologist as a consultant and the streamlining of pathologist responsibilities to those that require pathologist skill, are most reproducible, and most significantly impact patient care,” he says.

Here, Dr. Mettman shares his thoughts on his career in the laboratory, why connections count, and more.

What aspects of pathology and laboratory medicine do you find most intriguing and fulfilling, and how do these align with your personal and professional interests?

I find diagnosis through unique morphologic features or diagnostic combinations of morphologic and molecular findings to be most intriguing and fulfilling. Very few morphologic findings or known molecular findings are truly unique, so the examples of diagnostic morphologies or diagnostic combinations of morphologic and molecular findings are particularly satisfying and can provide comfort in a day filled with cases that necessitate clinical and radiologic correlation. Accordingly, I am interested in the elucidation of diagnostic mutational signatures as I am hopeful that the identification of such signatures can expand the number of diagnoses that can be made definitively on morphologic and molecular grounds.

Pathologists often collaborate with other healthcare professionals to provide comprehensive patient care. Can you describe a situation where you effectively collaborated with colleagues from different disciplines to optimize patient management?

I have had multiple cases where in reviewing the patient’s chart I have noticed that the patient has had >20 adenomatous polyps, recommended germline genetic testing to the endoscopist, and had the patient test positive for a pathogenic germline mutation in a polyposis-associated gene. In these cases, identification of the mutations connected these patients and their families with geneticists so they could be managed with recommended counseling, surveillance, and risk-reducing measures.

How do you approach difficult cases where the results could have a life-changing impact on a patient?

As with all cases, I work very carefully and first focus on the most impactful parts of the case. I use a systematic approach to comprehensively evaluate the case with redundant techniques for aspects that are at highest risk for error. Before rendering the diagnosis, I consider my provisional diagnosis in the context of the entire medical record. If something doesn’t fit, I may use ancillary studies or consult a colleague to support the diagnosis or explore other possibilities. If ultimately definitive diagnosis is not possible then I will carefully communicate the uncertainties, possibilities, and recommendations for subsequent management.