Changing the Dynamics of Quality Laboratory Medicine?Transparency Through Smartphone Technology Assures Accuracy in DIAGNOSIS

Our modern society is constantly changing through the influx of smartphone technology.  This truly allows patients to take charge of their health care, and partner with a physician or other health care provider.

The Clinical Laboratory Improvement Act was created initially in the early eighties (’80s) to bring some sense of consistency and uniformity to clinical laboratory testing process (We suggest for further information that one reviews the history of CLIA program).  While productive and practical standards, procedures, and protocols were created at the initiation of CLIA, there is still lack of transparency and accountability through medical laboratory testing; and we, believe this is primarily due to lack of appropriate communication between healthcare providers, and even patients. Early on in the CLIA standardization, and In an attempt to improve on this communication, hospitals and health insurance companies, as well as other organizations and third party entities decided to form BIASED, RESTRICTIVE,  AND SHOULD BE UNLAWFUL EXCLUSIVE SERVICE CONTRACT-relationship with a Pathologist and/or a Group of Pathologists to oversee the general operation of Clinical, Medical Laboratory Testing.  This contracted pathologist or group of pathologists led to the creation of the MEDICAL DIRECTOR of the Clinical Laboratory Operation, and  essentially prevented competition with other independent pathologists within the hospital or institutional setting The Medical Director was placed in charge of selecting the personnel  which would staff the medical laboratory, including sub-specialized pathologists.

Patients were left with inability to select specific pathologists to provide direct medical laboratory services to them in this regard.  Often times, this lack of Patient’s ability to choose provider for medical laboratory services placed patients in position of NOT being able to DEMAND QUALITY AND ACCURACY, as well as to control cost for their health care services with respect to the use of the Clinical Laboratory Testing, including diagnostic medical procedures.


With the initiation of smartphone technology and the various safe and secure operations that are currently used through smartphone technology, accountability and transparency can be assured for not only accuracy of test results, but also to share experiences that will enhance accuracy as well as to reduce cost through repetition of testing, for instance. 

The practice of teleradiology, as a parallel,  has gained wide popularity in this regard, and creates a level of competition that ensures lowering cost for these type services, which can be opined by various groups of radiologists simply through an internet connection, bringing world wide quality to patient no matter where he/she might be.  WE WANT AND SHOULD DEMAND THIS OPEN MEDICAL PRACTICE FOR PATHOLOGY and the MEDICAL LABORATORY TESTING OPERATION.  We, at MDC-Atlanta, believe that patients should be given the authority to choose which appropriately licensed healthcare professional provides laboratory medicine and pathology services to them, as they are allowed to choose internal medicine physicians, surgeons, and other health care providers, including medical specialists, to offer a wide range of clinical services directly to them.

Here are some practical examples of benefit for using TELEPATHOLOGY and TELELABORATORY SERVICES:

1. Patients CHOOSE who provides pathology and/or laboratory medical services to them, be it as an inpatient or outpatient.

2. Patients  have a “say so” about affordability for pathology and/or laboratory services

3. Immediate Second Opinion by World Renown Experts are available through Safe and Secured Smartphone Technology or other online services, with transparency and accountability of transmissible opinion/diagnosis/advice

4. Convenience of Diagnosis or Recommendation for treatment and/or further care improves turn around time so that patients get the needed care in a timely fashion.

Delayed Care May Lead to Advanced Diseases, as in a cancerous tumor which metastasizes or spreads to bone, liver, lymph node, and lung.











The Real Truth About Sexually Transmitted Infections

In the Most Simplest Language, Sexually transmitted infections, also known as Sexually Transmitted Diseases, ARE essentially PREVENTABLE.

There are helpful guidelines that are publically available for the general community, including patients, to review proper steps to prevent contacting a sexually transmitted infection.

Sexually Transmitted Diseases Treatment Guidelines, 2010

Recommendations and Reports

December 17, 2010 / 59(RR12);1-110  (refer to Centers For Disease Control)

The above reference is suggested as a guide with respect to specific types of Sexually Transmitted Infections (STI’s) which can be reviewed.
Often times, patients are confused as to the proper protocol for evaluation as well as treatment and management due to the variations in treatment and management through public and private clinical practices, as well as through resources on the internet.
In our practice at MDC-Atlanta, the following steps are taken to achieve a uniform evaluation and management for patients with potential STI/STD:
1. A complete, relevant recent protected or unprotected sexual history is obtained from the patient to guide with proper evaluation, diagnosis, testing and/or management
2. A thorough pelvic examination is performed using standard medical protocol and procedure
3. A pap smear sample is usually collected for immediate microscopic examination, directly looking for common STI’s such as HPV, HSV, trichomonas, etc.; or a swab smear from male urethra is reviewed under the microscope to examine for evidence of urethritis.
4. A sample is collected in transport media and submitted to appropriately credentialed Reference Clinical Medical Laboratory for appropriate  laboratory studies to confirm and/or reject the clinical impression for STI.
5. Based on the preliminary medical diagnostic impression, the patient is counseled and given appropriate preliminary, impirical treatment and management according to standards of medical care
6. The patient is then given an opportunity for question-answer session regarding further prevention and/or management of sexually transmitted infections, as well as appropriate follow up.
We at MDC-Atlanta remain committed to keeping our patients informed for better quality and safe medical care

The Real Truth about Telemedicine

 Wow, its been about Fourteen (14) Years since I, as a solo practitioner in Wyoming, first addressed how Telemedicine can work for modern medical care. Now, telemedicine is mainstream medical care where patients can truly take charge of their health, as demonstrated on ABC News CHECK THE VIDEO OUT HERE

Let’s talk Telepathology given the common diagnostic errors in the clinical laboratory due to lack of accountability and transparency. CLICK HERE FOR LAB ERROR STATISTICS


Examples of Previous Telemedicine/Telepathology Postings By MDC-Atlanta:





AT MDC-Atlanta, we make telepathology simpler and less expensive as compared to the above video demonstration.


1. Patients have a cellular or tissue biopsy done by their primary or specialist physician, and authorize sample to be submitted to MDC-Atlanta; or permanent pathology slides prepared by a CLIA licensed laboratory anywhere in USA can be simply mailed along with the Final Pathology Report to MDC-Atlanta

2. The cellular or tissue sample is transported in the appropriate transport medium via certified express mail at the expense of MDC-Atlanta to our practice address in Atlanta, Georgia. CONTACT DR. GATES FOR INSTRUCTIONS ON SPECIMEN HANDLING/TRANSPORT

3. At receipt of cellular or tissue sample or  prepared permanent pathology slide(s) by MDC-Atlanta, the patient and the physician will be personally notified by Dr. Gates, as well as direct communication about specific questions and/or other concerns to be addressed will take place at that time.

4. The cellular or tissue sample will be processed for macroscopic and microscopic description/identification regarding any pathological changes; or, the prepared permanent pathology slide(s) will be reviewed by Dr. Gates

5. A Final Complete Pathology Report will be issued to patient and/or physician with appropriate documentation via email, fax, or other forms of transmission upon request.

6. A video and/or picture of the salient diagnostic features may be presented to patient and/or physician with appropriate request. AN EXAMPLE OF TELEPATHOLOGY VIA VIDEO PRESENTATION

7. Second Opinion by other Nationally Renown Experts may also be provided at the specific requests of patient and/or physician, or as deemed necessary by Dr. Gates for Quality Control/Quality Assurance Policy at MDC-Atlanta

WE, AT MDC-ATLANTA, remain committed to keeping patients informed for better quality, safe, and affordable medical care!!

Plain Talk About Prevention and Maintenance of GI Diseases-A Pathologist’s Perspective

Normal Stomach HistologyNormal Colon Histology

Histological Examination Remains the GOLD Standard in Diagnosing Gastro-intestinal GI Diseases

Choose an Abdominal CT-Scan to RULE OUT TUMOR after a complete medical evaluation/assessment, then proceed with Endoscope if Necessary CLICK HERE FOR REFERENCE




At MDC-Atlanta, we give our patient a still-picture copy or video-presentation of the diagnostic pathological image of the patient’s BIOPSY, as this allows patients to understand their disease processes as well as to be able to share images

with other like-minded Experts


A common reason to seek the attention of a health-care provider is due to “stomach pain” associated with or without weight loss, decrease appetite, fever, chills, night-sweats, nausea, vomiting, diarrhea, and constipation, as these are symptoms that may suggest problems with the Gastrointestinal (GI) System. However, in general, GI symptoms essentially overlap with “constitutional symptoms” which means that other NON-GI diseases must be ruled out. This greatly depends on the patient’s age as well as other known medical or previous surgical conditions. The GI system is a central component for the operation of other human systems as it provides replenishing nourishment, water and electrolytes, as well as other trace elements. It is a system that is directly interactive with our external environment, and is therefore, predisposed to environmentally induced diseases. Because of its location from mouth to anus, neck, chest, abdomen, and pelvis, often times, the esophago-gastrointestinal tract is intimately apart of other systems, and may show overlapping signs of diseases that may NOT be directly linked.

Preventative and Maintenance Health Practices are key to solving many ailments that predispose the GI tract.

Most acute diseases involving the GI tract are typically self-limiting, which means they typically resolve within a few days, and really do not require the attention of a health care provider. We at MDC-Atlanta typically recommend those patients who are otherwise healthy that when experiencing acute GI symptoms, like acute diarrhea, nausea and vomiting without other symptoms, to “rest the intestinal tract” from solid foods, and only drink liquids which contain electrolytes and glucose, for instance, for one to two (1-2) days to allow healing of the lining of the intestinal tract to take place, as from acute viral infections for instance. Symptoms that do not show signs of resolution and/or become worsen WITHIN three (3) days should immediately require evaluation by a licensed health-care provider. Chronic diseases involving the GI tract typically last longer than three (3) months, and should always be evaluated by an appropriately qualified and licensed health-care provider.

Prevention and health maintenance measures regarding the GI tract start with an auspicious patient who monitors self for certain symptoms of GI diseases. Those who are predisposed to developing early GI diseases as related to congenital or inheritance pattern of diseases should always consult with the appropriate professionals regarding scheduled surveillance evaluation. But in general, surveillance of the GI tract by colonoscopy examination should be done by age 50 or sooner when certain symptoms are long lasting (chronic).  Specific symptoms  AT ANY AGE, such as sour taste in mouth after meal, or cramping/burning pain after meal, ongoing vomiting, or other symptoms related to gastro-esophageal reflux disease or gastric ulcers (bleeding), long-lasting diarrhea/rectal bleeding, etc, should ALWAYS be immediately evaluated by a gastrointestinal physician-specialist to rule out patterns of disease via biopsy and/or through microscopic evaluation. I hope someday patients will be able to do their own GI/Bowel prep (fasting for at least 12 hours), followed by swallowing a pill with a camera and small thin-tube with light attached to it to evaluate the upper GI tract (Esophagus, Stomach, and first part of the Duodenum-small intestine) as well as to gather images and even an automated safe biopsy apparatus-collector guided via secure-internet by their primary care physician to rule out diseases earlier before advanced stages.

Common Diseases of the GI TractBasic Functions of the GI TRACT

  There are many more diseases of the GI tract not listed in the above image for the sake of brevity.  These diseases include but are not limited to polyps with or without high-grade (precancerous) changes, ulcers, fungal infection, bacterial infections, etc. Diseases of the GI tract can be divided into TWO (2) main categories: REACTIVE VERSUS NEOPLASTIC (Benign or Cancerous).  Neoplastic diseases are first ruled out by examining a biopsy sample, for instance, under the microscope primarily looking for “PRESERVATION OF THE USUAL OR NORMAL MUCOSAL ARCHITECTURE“, also known as the normal histological pattern.  Neoplastic or tumoral diseases are common place in the GI tract, and generally do not pose significant diagnostic dilemma. However, when evaluating for INFLAMMATORY OR REACTIVE CONDITIONS of the GI tract, appropriate skills must be employed to communicate clinical relevance of the inflammatory lesions, so that appropriate medical therapy can ensue.

GI  inflammatory lesions are further divided into ACUTE versus CHRONIC:


The typical mucosal histological pattern is usually preserved.  However, there may be various forms of regenerative changes or ulceration of the lining surface epithelium.  In addition, acute inflammatory cells, neutrophils, permeate the lining surface epithelial cells, as well as the cells that form the crypt glands, or deeper glands, and may often be seen in clusters within the glandular lumen (neutrophilic abscess, also known as acute cryptitis/crypt abscess for intestinal disease for example).  The lamina propria shows accumulation of mixed inflammatory cells including neutrophils, lymphocytes, plasma cells, histiocytes, including lymphoid aggregates on occasion, and other inflammatory cells, with associated edema or fluid collection within the supporting connective tissue.  Acute GI diseases are caused by ischemia (changes in vascular flow to the mucosa), microorganisms, and/or other toxins.


The mucosa is usually distorted by branching glands, “glandular drop out”, irregular spacing of glands, atrophy, etc.  Activity of chronic inflammatory diseases of the intestine may again be highlighted by the presence of neutrophils within epithelium or glandular lumen, as with active inflammatory bowel diseases (Ulcerative Colitis and Crohn’s disease).  The lamina propria is typically expanded by a mixed inflammatory cell infiltrate as described above in the acute process, but also may or may not include various degrees of lymphoid aggregates and/or granuloma formation. There may be various degrees of increased collagen or fibrous tissue formation, as with collagenous colitis or lymphocytic colitis (which also shows the presence of increased numbers of lymphocytes within the epithelium, and nuclear dusting of the lining surface epithelium).   Chronic GI diseases are often caused by an immune mishap, and requires additional serological studies for instance, as well as other specific clinical findings to further define the abnormality.

Treatment of inflammatory diseases of the GI tract includes different types of antimicrobials, corticosteroids, as well as other forms of chemotherapy, and is influenced by the SPECIFIC TYPES OF INFLAMMATORY DISEASES. If you are diagnosed with one of these diseases, you should consider A SECOND OPINION by a different pathologist unaffiliated with the original pathologist, OR request EVIDENCE for the disease, by way of a picture or other clinical diagnostic evidence for disease.

MDC-Atlanta Remains Committed to Keeping Our Patients Informed for Better Quality and Safe Medical Care


mobile-medicine_1    CLICK HERE FOR DETAILS

Dr Gates at the Microscope Desk Interpreting Diagnostic Pathology

Dr Gates at the Microscope Desk Interpreting Diagnostic Pathology


 Transparency at the Microscopic level


Digital Based Pathology and Laboratory Medicine.  This process allows Dr. Gates to share cases with other pathologists and physicians all around the WORLD for TRANSPARENCY IN ACCURACY of DIAGNOSIS

Plain Talk about Skin Rash from a Pathologist’s Perspective

Skin rash is a common reason why patients visit or consult with a health care practitioner. However, many skin rashes are self-limiting, i.e. Self-limiting rashes subsequently disappear without treatment within two (2) weeks.

There are several principle morphological components of the skin that one may evaluate when considering rashes and other lesions of the skin. They include: 1) Epidermis; 2) Papillary dermis; 3) Reticular dermis; and 4) Subcutis, or subcutaneous fatty tissue. One may readily define each of these components through referencing a basic, general Anatomy and Physiology textbook.

When examining skin tissue under a light microscope, the principle goal is to define the normal histological pattern of skin, and this is based on where the skin is located on the body. The normal histological pattern is assessed primarily to exclude benign and cancerous tumors of the skin, also known as skin neoplasms. Once skin neoplasm has been ruled out by examining the skin under a light microscope, the second step is to consider reactive or inflammatory lesions of the skin also known as skin rashes or dermatitides, and thus, the topic for this discussion.

Normal Skin as viewed under the Light Microscope

Reactive or Inflammatory Skin Diseases can be subdivided into acute, sub-acute, and chronic dermatitides, and this categorization of skin inflammatory diseases is based on changes in the epidermis, dermis, and subcutis. Often times, acute inflammatory skin diseases as related to allergy for instance, will disappear within days after contact with allergen or other toxins have been removed; or after appropriate treatment with antiviral, antibacterial, antifungal, etc., medications for another example; or still yet after resolving an acute vascular insult as still another example. Sub-acute and chronic dermatitides generally last longer, and often require expert evaluation by a dermatologist for further therapeutic and prognostic management, generally after a skin biopsy and histological diagnosis have been rendered by a pathologist.

Evaluating the Epidermis:

An acute and/or subacute insult of the epidermis may demonstrate a range of changes from as mild as intracellular edema, also known as spongiosis to as severe as evidence of dead (necrotic) epidermal cells and ulceration (disruption or absence of) lining epithelial cells.

A chronic or long lasting (greater than three months) insult of the epidermis may show similar changes as to the above, in addition to reactive overgrowth also known as hyperplasia (given the two classifications: pseudoepitheliomatous hyperplasia and psoriasiform hyperplasia).  The pattern of keratin (hyperkeratosis) may accompany overgrowth of the epidermis, or the presence of parakeratosis may give evidence for rapid or continuous keratin turnover as with pruritus or chronic itching/scratching. Degenerative changes of the basal cells (vacuolar ‘bubbly’ degenerative changes) may also define the dermatitides. Vesicles or bullae may be seen in both acute and chronic dermatitides and the pattern of the bullae, i.e. intra-epidermal and subepidermal, may shed light on specific types of rashes that often times require even specialized studies such as immunohistochemistry to define abnormal autoantibody complexes. The pattern of Intra-epithelial inflammatory cells found within the epidermis and adnexa (sweat glands, sebaceous glands, hair follicules, etc) may also shed light on specific diagnosis of acute and chronic dermatitides. And, finally, specific pathogens such as viruses (viral cytopathic effect, as with Herpetic or Zoster viruses, for example), or Fungi (candida, dermatophytes, etc), or bacteria such as staphylococcus for example, may also be demonstrated as the etiology of the rash.

 An Example of A Chronic Rash, JGATES (2)Prurigo, Chronica


Evaluating the Dermis:

The inflammatory pattern is one of the most important features when defining rashes, as well as the specific types of inflammatory cells that are present within the dermis. Six (6) patterns are commonly evaluated which include: 1) superficial and/or deep perivascular inflammatory infiltrate with or without eosinophils or mast cells; 2) Superficial and deep perivascular inflammatory infiltrate comprised predominantly of lymphocytes and plasma cells with or without a periadnexal component; 3) Diffuse, mixed inflammatory infiltrate of dermis and/or subcutis; 4) Lichenoid or interface (a linear pattern of inflammation at the junction between the epidermis and dermis);5) Bullous inflammatory infiltrate, and 6) Fibrinoid necrosis (evidence of dead endothelial cells involving cells which line blood vessels) and clots within small blood vessels.  Granulomatous inflammatory infiltrate is a specific pattern that may be attributed to deep fungal infection or mycobacterial infection, etc, of the skin or Non-infectious granulomatous infiltrate as seen in sarcoidosis.

Examples of Descriptive Inflammatory Diseases of Skin ( Dermatitides):

Most common, acute rash: Urticarial Reaction; Sub-acute Spongiotic Dermatitis (includes allergy, contact dermatitis, other self-limiting dermatitis); etc:

-Spongiosis with superficial  patchy perivascular  lymphoplasmacytic and histiocytic inflammatory cell infiltrate with eosinophils and/or mast cells

Acute/Sub-acute rash: Arthropod/Insect Bite; Scabies, fixed drug-eruption,  etc

-Spongiosis with superficial and deep lymphoplasmacytic and histiocytic inflammatory cell infiltrate with or without eosinophils.

Chronic rash: psoriasiform dermatitis (requires clinical correlation), includes: Psoriasis (various forms), Neurodermatitis, Superficial fungal infection, etc:

-pseudoepitheliomatous hyperplasia/psoriasiform hyperplasia, plus or minus intraepithelial inflammatory cell infiltrate,  with superficial and deep lymphoplasmacytic and histiocytic inflammatory cell infiltrate WITHOUT eosiniphils and/or mast cells

Chronic rash: Lichenoid dermatitis (requires clinical correlation), includes: Lichen Planus, Discoid Lupus, Drug-eruption, etc.:

– Linear, Interface inflammatory lymphoplasmacytic and histiocytic inflammatory cell infiltrate, vacuolar degeneration, with or without superficial and deep lymphoplasmacytic and histiocytic perivascular inflammatory cell infiltrate and/or lymphocytic periadnexal inflammatory cell infiltrate.

The above are just some examples, but there are many other inflammatory dermatitides, including rare and special types such as deep fungal infection, parasitic infection, Herpetic dermatitis, Lyme disease, Sweet’s syndrome, Bullous Dermatitis, Erythema Nodosum,  Toxic Epidermal Necrolysis (TEN), etc.


Evaluating the Subcutis:

This is typically a limited evaluation looking for specific diseases related to causes of septal and diffuse panniculitis which tend to be systemic as related to calcium metabolic deposits (saponification), pancreatic and/or kidney diseases for example.

In short, defining rashes can be routine for the general health-care pracitioner. AND, using the above diagnostic evaluation profiles by the laboratory medicine specialist can define many different types of acute, sub-acute and/or chronic rashes (dermatitides).  Patients in general can save on health care cost for common rashes by going to visit a general practitioner/laboratory medicine specialist like Dr. Gates  prior to consulting with a dermatologist.


Most acute rashes will be self-limiting and typically resolve without therapy once the allergen or toxin has been removed.  But in general, most inflammatory dermatitides (skin rashes) can be resolved through corticosteroids, antihistamines, antimicrobials, or other topical and/or systemic  chemotherapy agents as predicated by the specific etiology of the rash.

We at MDC-Atlanta remain committed to keeping patients informed for better quality and safe medical care.

Second Opinion Requests for Dr. Gates

We are excited to expand our TELEMEDICINE and TELEPATHOLOGY Practice

throughout the State of Georgia .

Digital Based Pathology and Laboratory Medicine; Image can be shared with Experts ALL over the WorldTransparency at the Microscopic level ! We at MDC use the SmartPhone Technology to take Mobile Pathology Images

Breast Cancer! This Image was taken with an IPHONE camera allowing Rapid Second Opinion on the SPOT

Dr Gates at the Microscope Desk Interpreting Diagnostic Pathology

Dr Gates at the Microscope Desk Interpreting Diagnostic Pathology


We would like to announce, Telepathology, Preparing a Video of Your Biopsy, Click Here

Here are the steps for patients to take in regards to having Dr. Gates generate a video presentation of your diagnostic biopsy from any source of the body:

1. Contact Dr. Gates with regards to your interest to have a Video Presentation of your diagnostic biopsy (Click here to Contact Dr. Gates)

2. A form will be provided to the patient by Dr. Gates for the patient to complete, and mail to the institution or laboratory that originally diagnosed your tissue or cellular biopsy:

                                                                                                                                  MEDICAL RELEASE FOR MEDICAL RECORDPATHOLOGY SLIDE REVIEW-MDC ATLANTA

Click on the above  image and print copy of this form to be completed by Patient

3. The Original Institution and/or Laboratory who diagnosed your biopsy will send appropriate slides, pathology report, and other clinical particulates to Dr. Gates. PATIENTS ARE EMPOWERED TO REVIEW THEIR LAB RESULTS

4. The diagnostic material will be transferred to medical custodianship of Dr. Gates’ medical practice temporarily, and then returned back to the original institution and/or laboratory.

5. A final Copy of Dr. Gates’ second opinion report will be sent to the patient and the original institution and/or laboratory.

6. Recommendation for additional therapy, diagnosis, and or management will be provided to the patient by Dr. Gates, along with references to support the final diagnosis.

Thanks for your continual support of Medical Diagnostic Choices, as MDC-Atlanta remains committed to keeping patients informed for better quality and safe medical care.