"Who Will Do My Autopsy?"

[schrute]

Interesting article in Archives by Dr. Geller [link below]...and by interesting I mean sad & predictable. Aside from the first half of the article consisting of self-aggrandizement and name dropping, the remainder is a classic example of why our profession is where it is: more time is spent lamenting a bygone era (including the practices in which it constituted) than attempting to understand WHY things are currently the way they are & hence the root of the problem.
I have the utmost respect for Dr. Geller as a peer. But 'who will do my autopsy?' Not I, says the community pathologist spending all his time generating [or trying to generate] revenue (ie. not spending hours on end prosecting bodies that undoubtedly have a likely if not obvious cause of death from years and years of prolonged documented disease), pleasing administrators & staff, dealing with school loans and accompanying interest rates that were unheard of when Dr. Geller was in the same boat, living outside the confines of the insulated ivory tower of academics, and managing (and trying to predict) the next cut to my livelihood. Did I mention pleasing administrators? Add to that CAP, CMS, the ABP, and a host of other regulatory agencies and organizations that have come to define the practice of pathology in 2015.

Practices that are time consuming and generate zero financial gain (or, more accurately, have a net negative financial outcome) are going to fall by the wayside. I'm sorry that you want there to be an educational benefit in the identification of all parathyroid glands postmortem...it's quite noble of you as an academician. But nobility in medicine died when our role as educator was supplanted by the internet & our livelihood placed in the hands of bureaucrats, administrators, and insurance companies.

http://www.archivesofpathology.org/toc/arpa/139/5?ai=zt&ui=4ogf&af=H

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[Thrombus]

Hopefully no one does my autopsy. I wish to be left alone to rest in peace. Agree entirely with the sentiment expressed above.

 

[Over9000]

I swear that if we stopped doing autopsies entirely, and left the medicolegal stuff to fully-fledged forensic pathologists who would do their own residency from the start, we'd have more interest in our field.

Let's face it: medical students don't want to see any more dead bodies outside of their first year anatomy courses. I can tell you I am in that boat with them.

I have no idea what kind of person would desire to eviscerate a dead friend or colleague. It's sick. What is he going on about? No matter; that guy is one of our academic representatives. Lucky us. I bet he is very inspiring to a lot of medical students.

Outside of medicolegalities, what can an autopsy provide that's more important than everything else a pathologist does? Nothing. That's what. Signing out a piddly vasectomy specimen is more important than doing a medical autopsy. In fact, I'd say the autopsy has been entirely replaced with a far more useful tool: cross-sectional imaging.

What a fool, suggesting that because radiologists cannot and will not do forensic imaging for free, that pathologists should be expected to.

Old guys like Geller fail to understand EBM, medicolegal risk, time management, fiscal management, technological advancement and other such realities. If he really cares to go count parathyroids, he should do radiology.

 

[scienceguy19]

so who will do my autopsy?

that actually raises an interesting question. Can I include in my advanced directive that I would like an autopsy performed on me? (Let's say, I died in the hospital. Would my premortem written wishes for an autopsy to be performed on me after death be equivalent to post-mortem consent by a family member?)

Maybe I should oblige the pathology residents unconscious desire to eviscerate me and deliver my brain.

 

[AZpath]

I swear that if we stopped doing autopsies entirely, and left the medicolegal stuff to fully-fledged forensic pathologists who would do their own residency from the start, we'd have more interest in our field.

Let's face it: medical students don't want to see any more dead bodies outside of their first year anatomy courses. I can tell you I am in that boat with them.

I have no idea what kind of person would desire to eviscerate a dead friend or colleague. It's sick. What is he going on about? No matter; that guy is one of our academic representatives. Lucky us. I bet he is very inspiring to a lot of medical students.

Outside of medicolegalities, what can an autopsy provide that's more important than everything else a pathologist does? Nothing. That's what. Signing out a piddly vasectomy specimen is more important than doing a medical autopsy. In fact, I'd say the autopsy has been entirely replaced with a far more useful tool: cross-sectional imaging.

What a fool, suggesting that because radiologists cannot and will not do forensic imaging for free, that pathologists should be expected to.

Old guys like Geller fail to understand EBM, medicolegal risk, time management, fiscal management, technological advancement and other such realities. If he really cares to go count parathyroids, he should do radiology.

I hate the "A" word too Over9000. I would be happy to never do another post.

However, Geller is correct the medical autopsy has become a lost art.

Published articles may show value but hospitals and other doctors don't much care.
In the end it was CMS and other payment systems that judged this for us.

Radiologist won't waste their time either.

 

[bberlioz]

I agree with the above posts.

Autopsies were critical to learn about clinically "unknown" causes of death, in a period when medical imaging and biochemical tests were not readily available.

However, now that we have all these diagnostic tools, in most cases, the cause of death is pretty evident clinically and do not require the "gold-standard" autopsy examination to confirm cause of death, unless there are medicolegal implications to do so.

 

[mlw03]

I'm a forensic pathologist, so autopsies are my daily work.

I agree with the above comments. I think non-forensic autopsies are on life-support, and may soon die completely. I think the reasons given above are correct.

 

[pathstudent]

Autopsy thyself pathologist.

 

[mlw03]

Autopsy thyself pathologist.

That would be very impressive. I think I'd pay good money to see that, particularly certain pathologists.

 

[Neopath]

Okay, a couple of things. I recently learned that once you die your body becomes part of your estate, that is, property of your next of kin. Thus, Geller can fuss all he wants, but ultimately the decision belongs to someone else even if he requests autopsy before he dies.

Second, I do hospital autopsies for a large medical center and much of our volume these days comes from outside contracts to include the prison system, surrounding community hospitals, the state forensic facility who can dump drug ODs on us, and private cases. I think the "regional autopsy center" is becoming the most viable approach for non-forensic autopsies these days. It makes more sense from a business stand point.

What I've learned doing hospital autopsies is that the landscape may change, but there will probably always be a place for it. This is because in large medical centers patients die, and it's often after a surgery or some invasive procedure, and the autopsy is necessary to help figure out what did or perhaps didn't happen. Then the lawyers come knocking.

I do both FP and hospital autopsy, and my hospital autopsies tend to be more driven by money/malpractice implications (and thus probably are more stressful) than much of what I do in FP. And to anyone who thinks imaging will supplant the autopsy, after a few depositions, the radiologists would probably gladly lob postmortem investigation back to the arena of the pathologist.

Hospital autopsy isn't for everyone. But, if you can stomach it, and become part of a thriving autopsy facility, it can be a nice niche. As Geller said, proficient autopsy pathologists are becoming rarer and rarer these days.