No Corpses!!!

[mudshadow]

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Are there any pathology specialties/general residencies that don't require ANY autopsy work?
Thanks.

 

[rirriri]

in an AP/CP residency...you only have to do 50 autopsies TOTAL....so suck it up and do them. The rest of Pathology residency has nothing to do with Autopsies...there is a huge variety of LIVING science in it.

 

[mudshadow]

in an AP/CP residency...you only have to do 50 autopsies TOTAL....so suck it up and do them. The rest of Pathology residency has nothing to do with Autopsies...there is a huge variety of LIVING science in it.

Yeah but what types of practice can you do after residency that never autopsy?

 

[Gut Shot]

CP only = zero autopsies.

 

[DarksideAllstar]

in an AP/CP residency...you only have to do 50 autopsies TOTAL....so suck it up and do them. The rest of Pathology residency has nothing to do with Autopsies...there is a huge variety of LIVING science in it.

While it is true that you only are required to have 50 posts for BE/BC, there is a decent chance that you may end up doing more than 50 depending on if you end up at an institution that does alot of them.

 

[tsj]

While it is true that you only are required to have 50 posts for BE/BC, there is a decent chance that you may end up doing more than 50 depending on if you end up at an institution that does alot of them.

I don't think many institutions are able to get 50 per resident anymore without the help of a cut em and gut em coroners month.

 

[Mindy]

Why do pathology residents not like autopsies? (It is a serious question, remember I am going into forensics!)

Mindy

 

[DarksideAllstar]

Why do pathology residents not like autopsies? (It is a serious question, remember I am going into forensics!)

Mindy

In general, it was ok. There were a couple of things that bothered me though.

1) Posts that were completely unnecessary. Me to chief resident- "So what is going on with this patient?" Resident: "He had urosepsis." Me: "So what am I looking for?" Resident- "??". I did like 6-8 posts where the patients came in for chemo or CABG or whatever and ended up developing documented urosepsis. I mean, really, was this necessary (consider #2 below).

2)The reports. The place where I was made you write this terribly (and unneccessarily) long discussion including like 3 primary literature references, even if the patient died as a result of septic shock. These attendings struck me as incredibly anal (the R ventricle is 0.25 cm thick not 0.2!) about things which didnt contribute alot to the case (and even admitted it).

Thats what bothers me. I did have 3-4 interesting cases where the cause of death was truly unknown (mainly because they couldnt put the patients into the CT scanner because they were morbidly obese). Those, in my mind, were educational.

 

[DarksideAllstar]

I don't think many institutions are able to get 50 per resident anymore without the help of a cut em and gut em coroners month.

Notice that I stated "chance that you will" and not, "you will" do more than 50. I have been told by many that the # of posts requested are diminishing. Yes, the ME month(s) are probably necessary to get to the magic number of 50 at most places.

 

[ermonty]

Why do pathology residents not like autopsies? (It is a serious question, remember I am going into forensics!)

Mindy

Hey Mindy. I too am applying for Path, but I cant say that I have a great desire to do autopsies. I can handle 50 during residency, or even more if it is required. But ultimately, when I'm out in practice, it's just not something I want to do. But look at it like this - you will always have a job! 😀

E-Mo

 

[moodydoc]

Why do pathology residents not like autopsies? (It is a serious question, remember I am going into forensics!)

Mindy

I would have to agree with Mindy about my surprise that so many of you hate doing autopsies. During my rotation, every case was interesting with an unknown question. The write-ups can be long but often the results of autopsies were presented at various grand rounds. The primary lit. served not only to educated the pathologist but also to the pat primary team on other ways to manage the pat., etc.

I will have to say that I was not looking forward to my autopsy rotation but in the end love it.

I guess I am saying, give autopsies a chance. 🙂

 

[pathdoc68]

I completed my residency at the most benign program with the kindest attendings and the most helpful diener on earth, no one ever hasseled me about my autopsies. Our reports were also really concise, no lit reviews. But, I gritted my teeth for each and every one of the stinking nasty 65 'topsies I conducted. I love science, medicine and histopathology, Cutting up dead bodies, full of feces, gas and fluid is just completely nasty. The smell...the mess...oh the horror!!! But seriously, I would say to myself each time - I can't believe I did all this studying to cut up rotting dead bodies which were not infrequently infected with deadly pathogens. C'mon -- do you really believe autopsies contribute to advancing medicine or improving patient care?? Don't believe the hype. Oh yeah - autopsies are completly uncompensated as well- that is how much the payor community believes in the value of the autopsy.

 

[mudshadow]

I completed my residency at the most benign program with the kindest attendings and the most helpful diener on earth, no one ever hasseled me about my autopsies. Our reports were also really concise, no lit reviews. But, I gritted my teeth for each and every one of the stinking nasty 65 'topsies I conducted. I love science, medicine and histopathology, Cutting up dead bodies, full of feces, gas and fluid is just completely nasty. The smell...the mess...oh the horror!!! But seriously, I would say to myself each time - I can't believe I did all this studying to cut up rotting dead bodies which were not infrequently infected with deadly pathogens. C'mon -- do you really believe autopsies contribute to advancing medicine or improving patient care?? Don't believe the hype. Oh yeah - autopsies are completly uncompensated as well- that is how much the payor community believes in the value of the autopsy.

Pathdoc68, I take it you don't do autopsies now. What does your practice consist of? Live slides/dead slides mostly?

 

[mcfaddens]

I enjoy performing autopsys for the most part. I dont mind getting my hands dirty. I think that the problem arises with the subsequent piles of paperwork. I dont mind doing an interesting case, everyone can learn from that, but I mean sometimes come on! A MI is a MI I didnt need 26 slides with severe autolysis to tell me that, same with patients whose med files encompass 36 charts filled to the brim with illegible jibber jabber and multiple known end stage medical disease. The forensic way (or at least method) is the way to go I feel as far as uncomplicated/uninteresting cases but some medical autopsy is unwarrented In my opinion. The again we all have to get our 50.

 

[yaah]

Why do pathology residents not like autopsies? (It is a serious question, remember I am going into forensics!)

I have never really understood it either. Personally, I have done ~70-80 and have learned something from all of them. Sure, they can be gross, but whatever, you get used to it really quickly, and you wear protective covering (as much as you like). And it isn't that stressful. I agree the paperwork can be frustrating to deal with but if you stay on top of it and get things done quickly it isn't a problem. My main problem was getting the staff to be willing to sit down and sign it out before the deadline.

There are residents I have heard of (although not here) who actually DROPPED AP from their training because they couldn't handle autopsies. This blows me away. I guess for some the emotional connection is just too great, although some people give up on autopsies before they actually do more than a couple and thus before they get familiar with them.

Everyone's first autopsy is weird. Lots of people get lightheaded, feel sick, get weirded out, can't sleep the night after, keep seeing the face, etc. Not everyone. But almost everyone has a reaction that could be termed unpleasant to some degree. This diminishes with time (quickly, I have found, often by the time the first case is ending) and people get over it.

 

[RyMcQ]

I did 58 autopsies my first year of residency and probably only 10 or so in the following three years. There were some that weren't very interesting from a pathological standpoint, but from an anatomic standpoint, they were fascinating. It's too bad that we didn't have fresh cadavers to dissect in medical school anatomy classes, as I would have learned much more than I did.

I was never overly grossed out by autopsies, but it helped that our dieners almost always ran the bowel. The smell of blood and fat bothered me a bit at first, but I got used to it fast. And I didn't like the reports, especially how they hung over my head for a few weeks after the post.

Now in private practice, I have done one full autopsy in 16 months. I have removed a brain from another cadaver to be sent for an Alzheimer's study at NIH. The hospital has to pay our group something like $1000 for us to do it (not a good deal for either of us), so they actually get on doctors' butts for requesting too many. This is just fine with me, as autopsies are so disruptive to our work flow.

 

[Mindy]

Hi Guys:

Thanks for the great responses.

Here are some follow-up questions (maybe more aimed toward the folks that enjoy autopsies):

How can we improve autopsy numbers? Are they worth improving? Are autopsies valuable to modern medicine? Do we trust that our AP residents actually learn how to perform decent autopsies?

If there is some folks with a particular interest, PM me. I would love to get a multi-institutional colloboration on this going.

Mindy

 

[moodydoc]

Hi Guys:

How can we improve autopsy numbers? Are they worth improving? Are autopsies valuable to modern medicine? Do we trust that our AP residents actually learn how to perform decent autopsies?

I can provide some information on the way that many of the autopsies work at my current hospital. Our director of the autopsy spends time with each service when the new interns come on duty. Additionally, autopsy results are presented at grand rounds for med, peds, ob/gyn, NSGY, etc. With the medicine department we have a "stump the attending" in which the primary diagnosis or primary cause of death is in question (remember we are a major refer for the region and people often come to us without previous care). A medicine attending is given the daily progress notes and allowed access to the pre-mortem labs, then has to come up with a diagnosis, it can be a lot of fun to watch the attendings get pimped. After the attending makes his pitch, the pathology attendings give the correct answer and the patholophys behind it. I believe through all these interactions everyone gains something and the other services gain an understanding of how an autopsy work and how it might benefit them.

I think that autopsies can be useful not only to us path people but often helps doctors on other services to understand how the pat might succumb to certain diseases. I think the ped autopsies often can demonstrate previously undiagnosed abnormalities.

We also receive several brain only samples.

While I expect lots of disagreement, I believe that residents could benefit from an increased requirement for autopsies.

I have to agree with the previous comment about learning anatomy through autopsies.

 

[yaah]

Here, every time a patient dies part of the paperwork includes a line that the person's family has to sign, either refusing or agreeing to an autopsy. So they are supposed to bring it up to everyone. I am not sure this works as it should though, I get the feeling some clinicians say something like, "You don't want an autopsy, right? Just sign here," or alternatively they say the person is too distraught and they sign for them.

 

[DarksideAllstar]

I can provide some information on the way that many of the autopsies work at my current hospital. Our director of the autopsy spends time with each service when the new interns come on duty. Additionally, autopsy results are presented at grand rounds for med, peds, ob/gyn, NSGY, etc. With the medicine department we have a "stump the attending" in which the primary diagnosis or primary cause of death is in question (remember we are a major refer for the region and people often come to us without previous care). A medicine attending is given the daily progress notes and allowed access to the pre-mortem labs, then has to come up with a diagnosis, it can be a lot of fun to watch the attendings get pimped. After the attending makes his pitch, the pathology attendings give the correct answer and the patholophys behind it. I believe through all these interactions everyone gains something and the other services gain an understanding of how an autopsy work and how it might benefit them.

I think that autopsies can be useful not only to us path people but often helps doctors on other services to understand how succumb to certain diseases. I think the ped autopsies often can demonstrate previously undiagnosed abnormalities.

We also receive several brain only samples.

While I expect lots of disagreement, I believe that residents could benefit from an increased requirement for autopsies.

I have to agree with the previous comment about learning anatomy through autopsies.

I didn't mind doing the post as much as everything else that went along with it. Plus, signing out/doing these with junior research faculty who didn't know much more about the findings than the residents most of the time was a complete waste. I grew quite tired of showing organs/slides around to many different attendings trying to get a damn case signed out. And yeah, it was a nice anatomy review.

 

[CameronFrye]

I don't mind the actual autopsy. I find them to be somewhat surreal and usually entertaining. There have been times when I'm elbow deep in blood and feces and I'm amazed that I'm actually getting paid for it. That being said, the paperwork does get on my nerves (especially if I'm waiting on a bunch of cultures and other ancillary studies to be completed). Also, I feel that one day on surg path is probably more educational than an entire week or two on autopsy (but the lighter hours are certianly refreshing).

I think this article has been posted before, but I think it bears reposting:

http://www.nytimes.com/2005/04/24/m...faf8b9ef5c8e06&ei=5088&partner=rssnyt&emc=rss