There are an infinite number of ways to divide any population into two or more groups. Some may be modestly useful, most are not, and all are subject to often large exceptions. Nonetheless, one perhaps thought- provoking way to think about surgical pathologists is to consider whether they (or you) are primarily "morphocentric" or "clinicocentric."
First there are those for whom the recognition of a subtle microscopic pattern brings great gratification and, in and of itself, provides the major source of enjoyment from being a pathologist. These are the "morphocentric" pathologists. Experts with this tendancy are often "splitters" and have defined many of the entities that we recognize today. We owe them a great deal. They are often but not invariably found in academic institutions. In its heyday, the AFIP was a bastion for morphocentric pathologists, and a huge number of entities was "born" in that windowless building (bunker). Morphocentrists are not unaware of the clinical consequences of their pathologic discoveries, but the consequences may not always be fully considered or emphasized. Any consultant is removed to a degree from the patients supplying the diagnostic tissue, and the AFIP was a purely consultative service often far removed from the clinical results of its diagnoses. It has been argued that because of this and the fact that many cases seen at the AFIP were recurrent or otherwise problematic, there was a tendency to over emphasize aberrantly aggressive behavior leading to over labelling some entities as malignant. An example would be "well-differentiated liposarcoma of the extremities," a lesion now generally diagnosed as "atypical lipomatous tumor," and of course there are others. I don't mean to pick on the AFIP. Their contributions to pathology are beyond measure, but they are the best and largest example I can think of, of a collection of pure, or nearly pure morphocentric pathologists.
Historically many surgical pathologists began their careers as surgeons, internists, gynecologists or other clinicians who became enamored with pathology and switched careers but maintained their strong clinical ties. I'll call these "clinicocentric" pathologists. This was the norm in the infancy of surgical pathology, and the giants such as Stout, MacCarthy, Ackerman, and others who followed this path retained a strong clinical orientation. They were experts at morphology but their primary concern was always how the disease would behave and what would be the best course of treatment for the patient. They were attracted to surgical pathology because it is the pathology of the living and they enjoyed influencing patient care. They often had discussions at the microscope with the patient's surgeon. Mapping a course of action was more important than the words placed on the pathology report. Since few pathologists today begin their careers as clinicians, trainees with a built in clinical bias may be fewer in number, but this approach can still be taught and is taught in many programs today. If you enjoy discussing cases with your clinical colleagues, presenting cases at working tumor boards, etc., you may be a clinicocentric pathologist.
Whether you are morphocentric or clincocentric may affect the terminology you adopt to describe a new entity. "Carcinoma in-situ" is a distinctly morphocentric term because it acknowledges the morphologic identicality with invasive carcinoma, though ironically it was first used by Broders at the Mayo Clinic, a distinctly "clinicocentric" institution. Subsequently, howvever, other clinically oriented pathologists argued that this term was fraught with the potential for misunderstanding and carried the emotionally powerful designation of "carcinoma" for a non-metastasizing lesion. From this concern came the growing list of intraepithelial neoplasias, initially championed for the cervix by Ralph Richart, a gyncologist/gynecologic pathologist with a distinctly clinical "bent."
At the extreme, your "centricity" may color your diagnoses. In the early days of my training, my clinicocentric mentors would often discuss cases with the submitting clinicians while I was in attendance as the resident or fellow. If the case were borderline morphologically, a decision was often made based on which diagnosis was likely to do the patient the least harm. A true morphocentrist might never consider this approach. Thus, if the surgeon knew that the patient was an overt cancerphobic likely to demand overly aggressive therapy, a small focus of atypical glands/ducts in the prostate or breast was likely to be called "atypical" but not clearly malignant/in-situ, whereas such a "shading" of the diagnosis would not be required if the biopsy came from an 85-year-old patient not to be treated further, regardless of the terminology applied to the lesion. The same technique might also be applied when the surgeon was known to be overly aggressive! Today, this approach leaves you liable to being labeled by the "experts" as incompetant and and may leave you liable for much more when the lawyers come calling. Yet, which approach is ultimately better for the patient?