autopsies

[Arctic Char]

hey all. i'm an MS3 with a history of posts in the step 1 forum and the emergency medicine forum. i am beginning to consider pathology as a possible career choice. here's a rub to the story though: before med school i had worked very very briefly with an M.E., as an autopsy assistant and i hated it. i hated collecting dead and decaying people from all over town, and i thought the autopsies were nasty and brutal. i'm not an easily grossed out person at all, but i really didn't like these forensic autopsies. so my question is: does this mean path is a bad choice for me? i love looking at slides, i have a strong laboratory background, and i find the field interesting and the study of pathology fun. what do you think?

thanks everyone

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[mlw03]

pathology is certainly an option for you, just not forensic path. residency requires doing 50 autopsies total (hospital or forensic), but beyond that, if you don't want to do autopsies you don't have to. so you deal with a few months of something you don't enjoy, and then you focus on another area within pathology for your career. that simple. best of luck to ya!

 

[Gut Shot]

what do you think?

For most people autopsies are just something you put up with. As mlw03 mentioned, you need 50 to sit for boards. After that, if it's still important to you, there are jobs with little or no autopsy responsibilities. It's such a minor component of the job that I wouldn't let it deter you.

As an aside, I just entered my last case into the ACGME site and I have 49. Motherf*cker.

 

[yaah]

Don't let the ickiness of autopsies be the deciding factor. Decomp cases are smelly and disgusting. They are interesting but unless you do forensics you are unlikely to encounter many of them. In my training I saw I think 3 of them, but I didn't do much.

If you like the rest of path you will probably learn to tolerate autopsies. Autopsies on the "freshly dead" are much less smelly and icky.

 

[CameronFrye]

As already mentioned, medical autopsies (which will make up most of your cases), are usually much "cleaner" than the forensics cases.

 

[PathJet]

cleaner

but still an autopsy

no worries.... i have seen the daintiest of people adjust to autopsy and do just fine and even go on to like forensics

really you need to examine "the whole package" for career decisions even though i am still a resident i have been around a bit and am convinced that every single medical specialty has major positives and negatives and it comes down to which specialty you are interested in and which specialty will your talents best be used to make you a good physician because there are constant ups in downs in a specialty, gluts and droughts, all of that --you really have to be happy with it no through thick and thin if thats possible--consider it like a marriage or a partnership or something

 

[Arctic Char]

hey thanks a lot everyone. i really appreciate the input and honest answers. can't say i've seen such patient and thoughtful responses in every sdn forum.

and people talk trash about pathologists . . . phbbbbb

thanks guys

 

[yaah]

and people talk trash about pathologists . . . phbbbbb

Yeah but why would you listen to them? A ignoramus talking trash is still an ignoramus. Just because someone speaks with some semblance of intelligence and authority doesn't necessarily mean they know what they're talking about.

The older I get, the more I realize that the vast majority of people are full of ****.

 

[Arctic Char]

 

[GreatPumpkin]

I do about 5 to 10 a year. Not my favorite thing, but it is such a small part of my job it is no big deal.

 

[Mindy]

Autopsies rock!

(In a forum mood while I watch the sox, I guess...)

Mindy

 

[SexiMexi]

and people talk trash about pathologists . . . phbbbbb

thanks guys

As I am still relatively new to medicine and interested in path, can you elaborate a bit on this?

What reputation do pathologists hold in medicine?

 

[Arctic Char]

nah nah, that was all said in jest. i think its easy for people who've never been in a path lab or worked alongside a pathologist to imagine a pathologist as some characature of an anti-social troglodite buried deep in the bowels of the hospital amongst the toe tags and preserved organs. but in all honesty, i have never heard a cruel word uttered about a pathologist in any hospital i have ever worked or studied at, and i have enjoyed my pathology profs in med school more than any other group of lecturers. so, if there is a reputation, then i think it comes from the imagination of lay people, not the characteristics of practicing pathologists as a whole.

 

[b&ierstiefel]

As I am still relatively new to medicine and interested in path, can you elaborate a bit on this?

What reputation do pathologists hold in medicine?

It varies...some clinicians who have reasonable heads on their shoulders appreciate the role of pathologists. Other ignorant people see pathology as a black box and expect a clear cut answer. Then when you say "clinical correlation is advised" some can get irritated.

Medicine is full of lazy people who don't want to think. They like to turf responsibilities and in cases where the biopsy findings are nonspecific, they still want the pathologist to figure everything out for them...pathologists can be the victims of those tendencies. Pathology is part of the workup...not the entire workup itself.

 

[KCShaw]

There are mixed emotions about autopsies even among attending pathologists. Many academic & private practice pathologists exude an air of distaste regarding them, and as a consequence the autopsy training at some places suffers. But that kinda leads into another discussion, filled with its own series of articles and extremes.

As everyone has said -- autopsy is a part of training, with a board requirement that residents are directly involved in the key aspects of a specified number; that number and the specific requirements to count an autopsy towards it is a point of ongoing discussion, in part because many programs have difficulty getting enough autopsies for their residents. Some programs also require you to spend 1 month with a local forensic pathologist. If you don't really enjoy it, and many do not seem to (egads!), that's okay because when you come out the other side as an attending it becomes a minimal or downright avoidable responsibility.

 

[mlw03]

i'm gonna bump this up to ask a specific question. i know that in the past the ABP has required more autopsies of residents prior to sitting for boards, but does anybody know specifics? i'm trying to write a paper on the subject, and i'd like to know when the chances were made. for example, when was the change to only needing 50 autopsies made? what did it used to be before that, and before that, etc? if anyone has an article on the subject, or suggestions about where i could obtain that information i would appreciate it.

 

[KCShaw]

There's a good bit out there on the "history of the autopsy," some better than others, but sadly I don't SEE, or have, any authoritative information on the changes to official resident requirements either. My suggestion would be to ask someone at the ACGME-RRC/ABP whether you could have access to old versions of the documentation as part of an educational project. The -last- change I believe was in the last couple of years, but I don't have a nice clear-cut changelog, so to speak.

There is this:
http://www.acgme.org/acWebsite/RRC_300_News/300n_Index.asp
Which is a brief list of recent path related newsletters from ACGME, but may not include anything useful. (Goes back to only 1999.)

You've got me kinda interested in the answer, myself...

 

[mlw03]

thanks for the info, KC. i already sent out some feelers to the ABP, but hadn't thought about the ACGME. i'll go ahead and do that. if i get an answer before someone posts it here, i'll share it with everyone else via a post.

 

[myofibroblast]

See, I'm pretty much that opposite. I'm starting medical school in August and the only thing I have ever been interested in is forensic pathology. It's the entire reason I wanted to go to med school and I've spent the whole semester doing an internship at the M.E.s office and I LOVE IT!! I will keep an open mind but I think the deciding factor will be whether or not I enjoy regular pathology enough to make it through the 4 year residency until I can get into fellowship.

 

[mlw03]

relax there, myofibro. it's great to enjoy your work, but you're at least 9 years away from being a practicing FP, and you have a helluva lot to learn until that time. so start by learning your basic science and clinical medicine as best as you can over the next 4 years. and also, find me the answer to my question if you can.

 

[Mindy]

Congrats Myofibroblast!

As a current FP fellow, I really love the field. It is a constant stream of high(ish) profile, newsworthy, exciting cases and mysterious, natural diseases (with a smattering of the routine which in forensics lingo means drug overdoses).

As far as performing autopsies, it is always hard for me to understand why pathologists do not like them. But, I have just come to accept "they aren't for everyone."

Let me know if you (or anyone else on the forum) are interested in training in Boston down the line. I'll be sticking around once my fellowship ends... (yes, thank you, congratulations are in order for me )

Regards,
Mindy

 

[green mantis]

Autopsies are a really funny thing. For the most part, autopsies aren't a big part of our current training. (Years ago, I've heard that residents did 200 autopsies.) However, it's what most laypeople & sometimes other physicians think pathologists do all day.

My previous PD mentioned that up to 20% of your autopsies can be shared, so in actuality, you only had to do 40 autopsies on your own.

In my opinion, autopsies on 21 week (just past being a surgical) stillborn fetuses w/ multiple congenital anomalies were the worst. I only worked on decomposing bodies at the coroner's office, so at least they were still quick.


----- Antony

 

[Pingu]

The older I get, the more I realize that the vast majority of people are full of ****.

Hence the reason that brown eyes are dominant.

i'm gonna bump this up to ask a specific question. i know that in the past the ABP has required more autopsies of residents prior to sitting for boards, but does anybody know specifics? i'm trying to write a paper on the subject, and i'd like to know when the chances were made. for example, when was the change to only needing 50 autopsies made? what did it used to be before that, and before that, etc? if anyone has an article on the subject, or suggestions about where i could obtain that information i would appreciate it.

I know that the changes to the autopsy criteria for sitting for the boards are very very recent. During the resident forum this past saturday, the abp executive vice president (Betsy Bennett) commented on the fact that as of now essentially any autopsy will qualify towards the 50, but if you try to submit 50 brain only cases they will call you on it. My best friend took the boards in 2006 and that was under the old criteria, so it is at least later than 2006. I just don't know if they published it anywhere.

 

[Gut Shot]

As far as performing autopsies, it is always hard for me to understand why pathologists do not like them.

I never liked them because they always got in the way of my other service duties. A month of FP gave me much more of an appreciation for autopsy pathology, however, so now I actually find them... enticing.

 

[KCShaw]

Yeah, I think the -latest- change is mentioned in one of those ACGME newsletters I linked to earlier. What's not clear is all the changes over time. We all know that "in the past" there were "a lot more autopsies" -- but how many were truly "required" versus simply getting through the workload is part of what I think mlw is trying to answer. It's somewhat easier to find information about -hospital- requirements & rates that have changed over time, such as JCAHO's old requirement of a specified autopsy rate for a hospital to maintain accreditation. (I think the last instituted number was 20%, but it was eliminated in ~1970, claiming a move in focus from quantity to quality, and probably driven in part by overworked pathologists as oncologic histology picked up speed and added to their workload.) I think it would be cool to overlap the history of the two.

 

[Arctic Char]

In my opinion, autopsies on 21 week (just past being a surgical) stillborn fetuses w/ multiple congenital anomalies were the worst. I only worked on decomposing bodies at the coroner's office, so at least they were still quick.


----- Antony

wow, i'm the exact opposite. i think the neonatal autopsies would be the most fascinating. i've done a few on kids, and its never fun to see a dead child, but as far as interesting congenital pathologies are concerned, i find it very intellectually stimulating. decomps, on the other hand, just creep me out no end . . .yuck!

 

[mlw03]

right, KC - i'm looking to find out exactly what changes were made by the ABP and in what years those changes were made. it's for a paper i'm writing, so specifics are always preferred. i left voicemail and email messages with the ABP, but so far no response. i suppose i should take advantage of the fact that i'm at usf for a few more months and just go visit them in downtown tampa, which i'd gladly do if i thought it'd get me the answer.

 

[yaah]

I know that the changes to the autopsy criteria for sitting for the boards are very very recent. During the resident forum this past saturday, the abp executive vice president (Betsy Bennett) commented on the fact that as of now essentially any autopsy will qualify towards the 50, but if you try to submit 50 brain only cases they will call you on it. My best friend took the boards in 2006 and that was under the old criteria, so it is at least later than 2006. I just don't know if they published it anywhere.

My impression from recently filling out the application was that it is basically up to your program director to certify that your list is satisfactory, and that there are at least 50 cases listed. All you give the boards is a cause of death and age, I think, it doesn't require you to say what the autopsy number is, if it was limited, shared, forensics, etc. It separately asks you how many shared autopsies you did, but there is no requirement listed. Now, perhaps after getting your application they then ask the PD for more specifics, but I doubt they go through that much effort in most cases. Maybe if you list cause of death as "alzheimers" or "gunshot to the head" on half of your cases, they will question you.

For mlw - the boards staff is apparently very busy, I don't know if they have any times of year when they are less busy (perhaps november or december?). But they probably ignore your emails and calls because they think it isn't critical, maybe they will get back to you in time? I don't really know where else to suggest you look, except perhaps asking pathologists at your school, like maybe the PD.

P.s. congratulations Mindy!

 

[b&ierstiefel]

Congrats Mindy!

 

[myofibroblast]

CONGRATULATIONS MINDY!! WOO HOO!! And thanks for the advice! I do tend to jump to gun a little......it's just so hard to be patient sometimes! Forensic path has been my dream since middle school and being accepted to medical has meant this can REALLY come true! It's unbelievable. F.Ps are VERY special physicians and I agree, it's not for everyone. I really feel like it's my calling, though. I know I have at least nine years....HAHA I will learn alot more about the process in the meantime. I have a quick question...I know most people do the combined CP/AP residency. Is it bad for your career if you just do the AP only residency? Or do you learn really valuable things in the CP component that would help? I didn't know what the thinking was on this...

 

[green mantis]

I know I have at least nine years....HAHA I will learn alot more about the process in the meantime. I have a quick question...I know most people do the combined CP/AP residency. Is it bad for your career if you just do the AP only residency? Or do you learn really valuable things in the CP component that would help? I didn't know what the thinking was on this...

It's only going to be 8 years of you do AP/FP. All of the residents from my residency that wanted to do FP did AP only. Why spend an extra year earning a low salary when you can go out & get a "real" job? CP isn't necessary because you're probably not going to be working in a hospital environment. If you want to do CP, I'm sure your PD can give you some rotations during your 3 years.


----- Antony

 

[Mindy]

Thanks guys!

(Boy, we've been at it here a long time, ehh?)

It does feel pretty good to be finally settlin' in a bit...


MFB: I personally think CP training is invaluable to forensics. I spend A LOT of time collecting and interpreting lab data, including tox and micro (constantly), vitreous electrolytes, and antemortem data. It is really helpful to understand the limits of clinical lab testing--and then be able to apply them to postmortem specimens.

Mindy

 

[Mindy]

I noticed I crossed Green Mantis' post (time-wise).

Ummm, there are obviously differences in opinion when it comes to this!

 

[myofibroblast]

Thanks Mindy! That is REALLY good to know! I have heard both ways but the pathologists i know that did CP/AP have not regretted it at all. The only reason it concerned me is because I have to do a traditional rotating internship the year after I graduate med school (I am going to an osteopathic medical school and I live in one of the 5 states that requires that year in order to practice and I don't want to ruin the chance of maybe getting to practice in my home state of Oklahoma) so that is already tacking on another year. That combined AP/FP program sounds pretty cool! I know they have one at UT Southwestern in Dallas. You are required to bass both boards certification before you can practice, that is the only stipulation.