Shared autopsies

[star23]

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So, it used to be that you could have only 10 of your total 50 autopsies be shared but now you can have an unlimited number of them shared. So why do they still ask on the board application how many of your total number are shared? Just for curiosity's sake😕?

 

[exPCM]

As usual the ACGME and ABP's answer to low quality residency programs that can't meet minimum basic standards is to lower the standards instead of close the programs.

 

[2121115]

So, it used to be that you could have only 10 of your total 50 autopsies be shared but now you can have an unlimited number of them shared. So why do they still ask on the board application how many of your total number are shared? Just for curiosity's sake😕?

A better question is why do non-forensic autopsies even still take place? Why is it necessary to fully gut a human being and dissect their organs to "just see what you can find" when they've been imaged and cath'd and arteriogramed and etc, etc and clinicians have no real questions about why the person died? So much can be answered through faster, minimally invasive, less expensive techniques. I know I will take some heat from some of the older pathologists out there who feel like advancements and technology should apply to every discipline except pathology, but that is my position. The only legitimate argument I can see is education.

 

[rockit]

A better question is why do non-forensic autopsies even still take place? Why is it necessary to fully gut a human being and dissect their organs to "just see what you can find" when they've been imaged and cath'd and arteriogramed and etc, etc and clinicians have no real questions about why the person died? So much can be answered through faster, minimally invasive, less expensive techniques. I know I will take some heat from some of the older pathologists out there who feel like advancements and technology should apply to every discipline except pathology, but that is my position. The only legitimate argument I can see is education.

I agree with you, but there are situations where the autopsy helps answer clinical questions. It would be better if we talked to the teams about what questions they needed answered.

 

[Parts Unknown]

So, it used to be that you could have only 10 of your total 50 autopsies be shared but now you can have an unlimited number of them shared. So why do they still ask on the board application how many of your total number are shared? Just for curiosity's sake😕?

It will improve your life if you refrain from questioning the ABP's motives.

 

[green mantis]

A better question is why do non-forensic autopsies even still take place? Why is it necessary to fully gut a human being and dissect their organs to "just see what you can find" when they've been imaged and cath'd and arteriogramed and etc, etc and clinicians have no real questions about why the person died? So much can be answered through faster, minimally invasive, less expensive techniques. I know I will take some heat from some of the older pathologists out there who feel like advancements and technology should apply to every discipline except pathology, but that is my position. The only legitimate argument I can see is education.

Education is important.

Personally, I think that there are very few instances when a full autopsy is warranted. Most autopsies should be limited. If clinicians think the person died of a MI, all we really need to do is a heart or chest only autopsy. Why do we need to run the bowel to look for adenomas, diverticulosis, etc? I'm sure loved ones would probably be more welcome to an autopsy if they knew we weren't cutting up the entire body.


----- Antony

 

[raspberry009]

A better question is why do non-forensic autopsies even still take place? Why is it necessary to fully gut a human being and dissect their organs to "just see what you can find" when they've been imaged and cath'd and arteriogramed and etc, etc and clinicians have no real questions about why the person died? So much can be answered through faster, minimally invasive, less expensive techniques. I know I will take some heat from some of the older pathologists out there who feel like advancements and technology should apply to every discipline except pathology, but that is my position. The only legitimate argument I can see is education.

We had a case where a 85 yr old lady had died alone in her apartment. She had multiple cardiovascular problems. The coroner could have just written off the cause of death as cardiac related... however.. the technician noticed that the tissue remained pink after 3 hours of fixation. We quickly had the apartment building evacuated and saved 8 lives from carbon monoxide poisoning.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com😳ffice😳ffice" /><o😛></o😛>

 

[schrute]

What's the number of autopsies we're willing to perform in order to make a clinical / legal difference? 1? 10? 50? I guess the answer depends on WHO is paying for the service.

In the near 50 I've done so far, there's only been a few that have genuinely unearthed something unknown or answered a medicolegal question.

Had an interesting one recently...elderly man with supposed Parkinson's, only to find that a previously noted calcified pericardial "nodule" was actually a thymoma, and he probably had a paraneoplastic syndrome (no Park, Alz or encephalitis on neuro)...in addition to an intravascular LBCL.

 

[2121115]

We had a case where a 85 yr old lady had died alone in her apartment. She had multiple cardiovascular problems. The coroner could have just written off the cause of death as cardiac related... however.. the technician noticed that the tissue remained pink after 3 hours of fixation. We quickly had the apartment building evacuated and saved 8 lives from carbon monoxide poisoning.ffice😳ffice" /><O😛></O😛>

What's the number of autopsies we're willing to perform in order to make a clinical / legal difference? 1? 10? 50? I guess the answer depends on WHO is paying for the service.

In the near 50 I've done so far, there's only been a few that have genuinely unearthed something unknown or answered a medicolegal question.

Had an interesting one recently...elderly man with supposed Parkinson's, only to find that a previously noted calcified pericardial "nodule" was actually a thymoma, and he probably had a paraneoplastic syndrome (no Park, Alz or encephalitis on neuro)...in addition to an intravascular LBCL.

In most, if not all, of these cases you can get to the same answers through minimally invasive techniques. I'm not saying don't do autopsies, but there is little reason to fully gut and dissect an entire human being to get a diagnosis.

 

[Autopsy Sweet]

In most, if not all, of these cases you can get to the same answers through minimally invasive techniques. I'm not saying don't do autopsies, but there is little reason to fully gut and dissect an entire human being to get a diagnosis.

I disagree. There are many times that highly trained radiologists with highly specialized imaging techniques were found to be wrong in their diagnoses. How are you to know which ones these are unless you do an autopsy? In addition, there's no way to image the vessels postmortem since contrast requires a beating heart for circulation. This is a huge limitation. In addition, full body imaging is exceedingly expensive when compared to autopsy.

In our institution, we call the treating physician prior to every autopsy to find out what they were looking for in ordering the autopsy. Sometimes the family has requested the autopsy, so there is no specific question to be answered but this is not always the case.

There have been quite a few times when we found things at autopsy that were misdiagnosed as something else during the patient's life. I've actually been surprised with the number of premortem diagnoses that have been wrong. So, the point of the hospital autopsy (non medico legal) should be not only for the edification of the pathology resident 🙂, but also for educating the treating physicians.

On a side note, the number of autopsies performed annually have dropped drastically since Medicare stopped specifically paying for them (included in DRG). I would like to know if there has been a rise in mistakes in medical diagnosis since then.....in 1998 it was reported that there was a discordance of greater than 40% in some hospitals between premortem diagnosis of cause of death and actual cause of death found at autopsy with over 2/3 of the causes found at autopsy being treatable conditions. On the other hand, I'm not sure that it has ever been demonstrated that higher autopsy rates increase accuracy of premortem diagnosis.

I'm obviously a believer in the autopsy. I do agree, though, that many times a complete is not necessary.....😀

 

[HbyHA]

I disagree. There are many times that highly trained radiologists with highly specialized imaging techniques were found to be wrong in their diagnoses. How are you to know which ones these are unless you do an autopsy? In addition, there's no way to image the vessels postmortem since contrast requires a beating heart for circulation. This is a huge limitation. In addition, full body imaging is exceedingly expensive when compared to autopsy.

i have been involved with at least THREE such cases during my training. A common thread through all of these cases has been that the clinical teams tended to ignore the diagnosis that fit best clinically in favor of what the radiologists suggested and end up going down a completely wrong path. Radiology is NOT perfect. i'm not knocking the radiologists at all here, just pointing out that there are limitations to the technology, much as there are with laboratory tests. Clinicians would do wise to remember this!