Some questions on autopsies?

[IcedTea]

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I am considering going into pathology in the future solely for autopsies. Here are my questions:

1) Can a general pathologist find a job to perform autopsies only or does he/she need to do fellowship training in forensic pathology to do autopsies only?

I'm asking because I know pathology includes a lot of examining specimens under a microscope and I'm not really interested in that; I mainly want to do autopsies.

2) Is a forensic pathologist the same as a medical examiner?

I know this is probably a really noobish question, but I've seen both these terms tossed around in various ways. I'm assuming yes, but I'm just asking to make sure.

 

[djmd]

I am considering going into pathology in the future solely for autopsies. Here are my questions:

1) Can a general pathologist find a job to perform autopsies only or does he/she need to do fellowship training in forensic pathology to do autopsies only?

I'm asking because I know pathology includes a lot of examining specimens under a microscope and I'm not really interested in that; I mainly want to do autopsies.

2) Is a forensic pathologist the same as a medical examiner?

I know this is probably a really noobish question, but I've seen both these terms tossed around in various ways. I'm assuming yes, but I'm just asking to make sure.

You want to only do autopsies, and not look in a microscope?

Ok, I'll feed this troll...

You want to be a Diener..
http://en.wikipedia.org/wiki/Diener

You don't need to go to medical school for this so if you profile info is correct, drop out now..

 

[IcedTea]

You want to only do autopsies, and not look in a microscope?

Ok, I'll feed this troll...

You want to be a Diener..
http://en.wikipedia.org/wiki/Diener

You don't need to go to medical school for this so if you profile info is correct, drop out now..

I'm considering pathology, but there's other specialties I have in mind as well.

I apologize if this question seems "troll-ish" but I don't know much about pathology yet. It's only recently that I looked more into it to see what it's about.

And the diener does not do autopsies btw. The diener just handles, moves, and cleans corpses as Wikipedia said. They don't do autopsies, they just manage a morgue.

 

[Ziehl-Neelsen]

An autopsy (also known as a post-mortem exam) is a diagnostic procedure done by a pathologist to answer specific clinical questions for clinicians or to determine a cause of death for medico-legal reasons.

Pathologists are uniquely suited to perform this exam because they train and specialize in the diagnosis of disease. As a medical student, I'm sure you realize that numerous methodologies are used to make a diagnosis (e.g. patient history, physical exam, radiological studies etc.). In much the same way, a number of methodolgies are used in a post mortem exam: serum chemistries, gross examination of organs and tissues, and microscopic examination of organs and tissues. Pathologists train in these and many other areas in order to make accurate diagnoses.

Your questions are confusing because, while it may be inapparent to you, the microscopic examination of tissue by a pathologist is an integral part of every autopsy. Also, gross examination of organs and tissues is quite easy and can be done by a number of people with minimal training. It is the microscopic examination of tissue that is supremely difficult, and it is this skill that pathology residents spend the majority of their time developing. Hence the suggestion by djmd to become a diener: if you are only interested in the gross aspects of a post-mortem exam, that interest would probably be best served by becomeing a diener. Contrary to poular belief, it is the diener who does the majority of the "cutting" during an autopsy.


So, in answer to your questions:

1. A fellowship in forensics would allow a pathologist to spend a career focusing primarily on autopsies. Yes, it is possible to have a career consisting solely of autopsies as a general pathologist, but it would entail finding an academic center or pathologist group that performed a very large number of medical autopsies and convincing them to hire you. This would be extremely difficult as autopsies are generally not a significant amount of the work for a general pathologist.

2. For all intents and purposes, they are the same.

 

[yaah]

So you don't know a lot about pathology, but you do know that you don't want to use microscopes? That's a little odd. And yes, if you don't want to use a microscope but you want to do autopsies you are going to have a hard time being successful, not to mention getting through residency. Perhaps you should try a bit before dismissing it?

In many cases (probably the majority) the diener does most of the cutting during the autopsy and a lot of the dissection - they pass the organs off to the pathologist a lot of the time. Wikipedia is (surprise) not very informed.

 

[IcedTea]

Thank you both for your replies.

Yes, I'm mainly interested in the gross aspect of autopsies, but I don't think I would want to become a diener. They make only about $30K per year, which is practically nothing.

I guess I could deal with the microscopic aspect of pathology, since microscopic examination of speciments, tissues, etc. is what pathology mostly consists of.

 

[djmd]

Thank you both for your replies.

Yes, I'm mainly interested in the gross aspect of autopsies, but I don't think I would want to become a diener. They make only about $30K per year, which is practically nothing.

I guess I could deal with the microscopic aspect of pathology, since microscopic examination of specimens, tissues, etc. is what pathology mostly consists of.

I am unclear as to what exactly it is that is drawing you to pathology or more correctly to forensic autopsies.

Maybe if you shared.

If you can't stand microscope work you will have a hard to making it through residency, and passing boards, and working as a forensic pathologist...

And lastly,
Forensic autopsy technician does a little better than 30k.. like twice that.
http://agency.governmentjobs.com/sf/default.cfm?action=viewclassspec&ClassSpecID=15165

I pulled that up with just a random search.
You might not make as much, but if the forensic autopsy is what you love..
You might be happier making less, but doing what you want..

 

[IcedTea]

I am unclear as to what exactly it is that is drawing you to pathology or more correctly to forensic autopsies.

Maybe if you shared.

If you can't stand microscope work you will have a hard to making it through residency, and passing boards, and working as a forensic pathologist...

And lastly,
Forensic autopsy technician does a little better than 30k.. like twice that.
http://agency.governmentjobs.com/sf/default.cfm?action=viewclassspec&ClassSpecID=15165

I pulled that up with just a random search.
You might not make as much, but if the forensic autopsy is what you love..
You might be happier making less, but doing what you want..

What's intriguing to me about forensic autopsies is mainly gross examination to find causes of disease and the "cutting" aspect of it. I love cutting up stuff lol, which is why I love surgery and the dissections I did in college, and am doing in med school currently. But examining humans post mortem just seems extremely fascinating to me.

I wouldn't really say I hate microscope work, but I wouldn't say that I like it much either. It's alright, but I know that a pathologist's job involves microscope work and that I will have to like it to get into the field and get through residency and work later on.

Thanks for the link, it was very helpful. I didn't know forensic autopsy techs made that much, maybe I will look into that career if that's what I really want to do, but I still will follow through with med school to keep my options open.

 

[SaveThisLabRat]

http://agency.governmentjobs.com/sf/default.cfm?action=viewclassspec&ClassSpecID=15165

Work environments entail exposure to deceased persons with severe traumatic injury, decomposed bodies and infectious cases, biohazards such as AIDS, tuberculosis, meningitis, hepatitis or any other human infectious agent; exposure to potentially toxic chemicals

😎

 

[IcedTea]

Work environments entail exposure to deceased persons with severe traumatic injury, decomposed bodies and infectious cases, biohazards such as AIDS, tuberculosis, meningitis, hepatitis or any other human infectious agent; exposure to potentially toxic chemicals

😎

I'm ready lol

 

[docbiohazard]

To somewhat redirect this thread, I was just curious if any residents wore cut-resistant gloves when performing autopsies. We had a lab supply rep come through hocking various "cut resistant" gloves, along with other things. They were made out of a fiber and would need to be worn under a latex / nitrile glove to keep from getting nasty, but I would think they might provide a nice extra protective barrier. Of course, trying to do an autopsy when you're wearing something akin to mittens might be more of a pain than its worth.

BH

 

[djmd]

To somewhat redirect this thread, I was just curious if any residents wore cut-resistant gloves when performing autopsies. We had a lab supply rep come through hocking various "cut resistant" gloves, along with other things. They were made out of a fiber and would need to be worn under a latex / nitrile glove to keep from getting nasty, but I would think they might provide a nice extra protective barrier. Of course, trying to do an autopsy when you're wearing something akin to mittens might be more of a pain than its worth.

BH

Only on HepC, HIV and the one CJ brain autopsies...

 

[mlw03]

To somewhat redirect this thread, I was just curious if any residents wore cut-resistant gloves when performing autopsies. We had a lab supply rep come through hocking various "cut resistant" gloves, along with other things. They were made out of a fiber and would need to be worn under a latex / nitrile glove to keep from getting nasty, but I would think they might provide a nice extra protective barrier. Of course, trying to do an autopsy when you're wearing something akin to mittens might be more of a pain than its worth.

BH

among the ME's i've worked with, all at least double glove. one wore a thick glove on his non-cutting hand, while the other two wore a thick rubber-type glove over their hands. so far when i've cut i've just worn 2 surgical gloves. as i start residency i'll probably play with different options. there's a fine line between adequate protection for yourself and maintaining enough dexterity to appreciate the texture of what's in your hands.

 

[djmd]

among the ME's i've worked with, all at least double glove. one wore a thick glove on his non-cutting hand, while the other two wore a thick rubber-type glove over their hands. so far when i've cut i've just worn 2 surgical gloves. as i start residency i'll probably play with different options. there's a fine line between adequate protection for yourself and maintaining enough dexterity to appreciate the texture of what's in your hands.

I've often heard that you get used to whatever you use regularly... I always double glove.
It doesn't seem to bother me...

The cut proof gloves are a different story... there is no way you can maintain texture and touch with them.. but that is small price to pay...
Generally I need less texture touch with autopsies anyways...

 

[LADoc00]

FYI:

*Anyone, literally, can perform an autopsy with proper permission from next of kin.

reread that: ANYONE. My Honduran housekeeper with no formal education can legally perform an autopsy in the state of California.

*Autopsies are not billed medical procedures under the California Business Professional Code.

*There is no autopsy CPT code.

*There is NO requirement to ever perform an autopsy outside of forensic cases. There is no regulatory requirement at all...NONE.

*JACHO removed minimum autopsy requirements for hospitals in 1971

*There is no 3rd party payor in the US I am aware of that reimburses for autopsies

*There is NO, NONE, NADA reimbursement from Medicare Part B for autopsies. People may claim "theoretically HHS reimburses through QA means" but theoretically Elvis is still alive too! There is no Medicare reimbursement for autopsies folks.

*Almost no family is willing to perform an autopsy unless they are considering legal action. This is very tricky because you can be subpeona'd and in some cases, depending on the state, get NO compensation for your time. Meaning, for the price of the autopsy you could be stuck doing weeks worth of work for FREE, aka a village idiot.

AUTOPSIES=EPIC FAIL.

 

[alois]

FYI:

*Anyone, literally, can perform an autopsy with proper permission from next of kin.

reread that: ANYONE. My Honduran housekeeper with no formal education can legally perform an autopsy in the state of California.

That might be true in California but it isn't true in some other places...

Connecticut (my bold):
PA 01-122-sHB 5426
AN ACT CONCERNING AUTOPSY ARRANGEMENTS AND STANDARDIZED INFORMED AUTOPSY CONSENT
SUMMARY: Unless the Chief Medical Examiner's Office performs it, the law prohibits a physician from performing an autopsy without the consent of the person who assumes custody of the body.

Massachusetts (again my bold):
105 CMR 130.381: Definitions
The following definitions apply in 105 CMR 130.382 through 130.387.
Autopsy means a post mortem examination performed by a physician, including the removal and examination of organs, to determine a medical disease, medical condition, or the cause and manner of death, or for other diagnostic, education, quality improvement, or research purposes.

New Mexico (just to show this isn't some East Coast elitist thing; again my bold):
24-12-4. Post-mortem examinations and autopsies; consent required.
A. An autopsy or post-mortem examination may be performed on the body of a deceased person by a physician or surgeon whenever consent to the procedure has been given...

or West Virginia: §16-4B-1. Autopsy on body of deceased persons in interest of medical science; who may perform; consent required; who may give consent.
In case of the death of any person in the state of West Virginia, except those deaths subject to autopsy being made pursuant to section ten, article twelve, chapter sixty-one of this code, the attending physician, or if there be none, any physician ...

or Kansas:
65-2893. Autopsies; performance of; authorization. In any case of death wherein notification of the coroner is not required by K.S.A. 19-1031 and amendments thereto, or any case in which the coroner does not elect to perform an autopsy, an autopsy may be performed upon the body of a deceased person by a physician or surgeon when so authorized

et cetera...

In fact, there remains (despite imaging, despite lab tests, despite physician skills) an important role for autopsies in helping families and physicians understand the course of disease, the cause of death, and the implications for the rest of the family. Most risk management professionals will tell you that more law suits are avoided by autopsies than are caused by them (or have autopsies done to support them).

 

[LADoc00]

Agreed, the state has defined what an autopsy is and who OUGHT to perform it. But that is a far cry from defining in law who the ONLY practitioners of autopsies should be. That would require penalities for non-licensed MDs who perform "autopsies" which in my reading of the law (and I have law coursework under my belt...) are non-existent. Descretion of the dead is against the law...but this falls outside that definition.

Autopsies could even be considered part of protected burial ritual under the "Freedom of religion" and Im am unaware of any prosecution in the US for the last 100 years brought on wrongful post mortem examination.

The second issue is whether an autopsy is even an actual medical procedure...

 

[pathstudent]

I read a NYT article about 1-800-autopsy. It was started by a deiner and he provides autopsy services to families now that they are so uncommon at hospitals. The guy does well (low 6 figures). That's not bad for a HS diploma and a little community college or OTJ training.

http://www.1800autopsy.com

 

[LADoc00]

I read a NYT article about 1-800-autopsy. It was started by a deiner and he provides autopsy services to families now that they are so uncommon at hospitals. The guy does well (low 6 figures). That's not bad for a HS diploma and a little community college or OTJ training.

http://www.1800autopsy.com

yeah there are DOZENS of fully licensed businesses in California that employ people to do autopsies who are not physicians, some of which have only on the job training in a morgue somewhere.

 

[mlw03]

yeah there are DOZENS of fully licensed businesses in California that employ people to do autopsies who are not physicians, some of which have only on the job training in a morgue somewhere.

what kind of report do these non-physician autopsies yield? do they actually provide families with useful information? and what do you mean by "fully licensed", given the absence of laws regulating this type of endeavor.

 

[LADoc00]

what kind of report do these non-physician autopsies yield? do they actually provide families with useful information? and what do you mean by "fully licensed", given the absence of laws regulating this type of endeavor.

fully licensed=California business incorporation+local city business permits, ie-fully operational, paying taxes without restriction.

the lack of the need to proceed at all through the CMB, California Medical Board, implies autopsies are not recognized medical procedures under the law.

Once again, autopsies=epic fail:

 

[IcedTea]

FYI:

*Anyone, literally, can perform an autopsy with proper permission from next of kin.

reread that: ANYONE. My Honduran housekeeper with no formal education can legally perform an autopsy in the state of California.

*Autopsies are not billed medical procedures under the California Business Professional Code.

*There is no autopsy CPT code.

*There is NO requirement to ever perform an autopsy outside of forensic cases. There is no regulatory requirement at all...NONE.

*JACHO removed minimum autopsy requirements for hospitals in 1971

*There is no 3rd party payor in the US I am aware of that reimburses for autopsies

*There is NO, NONE, NADA reimbursement from Medicare Part B for autopsies. People may claim "theoretically HHS reimburses through QA means" but theoretically Elvis is still alive too! There is no Medicare reimbursement for autopsies folks.

*Almost no family is willing to perform an autopsy unless they are considering legal action. This is very tricky because you can be subpeona'd and in some cases, depending on the state, get NO compensation for your time. Meaning, for the price of the autopsy you could be stuck doing weeks worth of work for FREE, aka a village idiot.

AUTOPSIES=EPIC FAIL.

Dang, I didn't know doing autopsies were that bad. lol

Seems like just about anyone can do it with a bit of training I guess.

 

[decal]

I've gotta get one of these...

http://www.1800autopsy.com/gift-catalog-item.html?Id=386

 

[IcedTea]

I've gotta get one of these...

http://www.1800autopsy.com/gift-catalog-item.html?Id=386

lol

 

[alois]

yeah there are DOZENS of fully licensed businesses in California that employ people to do autopsies who are not physicians, some of which have only on the job training in a morgue somewhere.

From the 1800Autopsy website:
[FONT=Verdana, Arial, Helvetica, sans-serif]2. Who can perform an autopsy?
A forensic pathologist, a medical doctor specially trained to recognize the anatomic and biochemical changes brought about by disease, will perform the autopsy.

.[FONT=Verdana, Arial, Helvetica, sans-serif]9. How long does it take to get the autopsy report?
Immediately following the procedure the pathologist will call the next-of-kin with a tentative cause of death. The final written report along with microscopic study will be available from four to six weeks.

10. Can a cranial autopsy be performed?
There is much confusion with this statement. There is no such thing as a cranial autopsy because an autopsy is to determine the cause of death. What the family is requesting is a neurological diagnosis whereupon the brain is procured and delivered to a forensic neuropathologist. A complete detailed report takes about twelve weeks.
-----------------------
This is a diener service -- saying that they are "doing autopsies" is equivalent to saying that your histotech is "doing surgical pathology". Even in academic centers which still have large volumes of autopsies, dieners mostly receive on the job training.

Yes, many hospitals have out-sourced the physical performance of autopsies to services (or to other hospitals) but there are still physicians who provide the diagnoses.
.

 

[docbiohazard]

I've gotta get one of these...

http://www.1800autopsy.com/gift-catalog-item.html?Id=386

Man, the gift catalog is full of all sorts of wacky stuff.

Although I know they are hated by many pathologists, seems to me that if there is any creep in terms of allowing non-MDs to "perform autopsies", we ought to be fighting it. If the reimbursement framework isn't there, we should have been fighting to institute it and should be continuing to do so to this day. Autopsies have a use outside of simple medicolegal wranglings, and conveying that to the people along with a greater understanding of pathology as a field and discipline would seem to me to be an important goal.

BH

 

[LADoc00]

I've gotta get one of these...

http://www.1800autopsy.com/gift-catalog-item.html?Id=386

well okay that is cool, but has nothing to do with doing autopsies...

 

[green mantis]

I read a NYT article about 1-800-autopsy. It was started by a deiner and he provides autopsy services to families now that they are so uncommon at hospitals. The guy does well (low 6 figures). That's not bad for a HS diploma and a little community college or OTJ training.

http://www.1800autopsy.com

The contact info doesn't list where they're located, but we used dieners from 1-800-autopsy when I was rotating at the VA in Long Beach, CA. The head honcho was a large Hispanic guy. Unfortunately, I can't remember his name. We stopped using them because they were just too busy & couldn't meet our demands. VA autopsies were lower priority than private ones since they got paid less.

On a side note, I always thought 1-800-autopsy would make a good daytime TV commercial, kind of like Larry Parker & those other accident lawyers. 😛


----- Antony

 

[Mindy]

Wow! How did I let this garbage thread slide by???!!!

Okay, lets clear up a few amazing lies:

1) I do the ENTIRE dissection, minus only the sawing of the calvarium, during an autopsy. NOBODY EVISCERATES MY CASES, BUT ME.

2) If the physicians who have responded that you do not need to be a doctor to perform an autopsy really believe it, I have to doubt their clinical skills. I will bet that they do not actually know how to properly eviscerate, maybe have never done so themselves. By the time I am done eviscerating (organ-by-organ), I have a working diagnosis. Cutting most of the organs just confirms I am not missing something (tumor, granuloma).

3) The term "diener" is really out of vogue, german for something like "man servant". Acceptable term is autopsy technician, though I am sure there are others.

4) 1-800-AUTOPSY is mostly an autopsy referral business with pathologists that are commissioned to perform autopsies arranged through the service. It is very successful.

5) Microscopy, toxicology, microbiology are FP staples.

6) My legal counsel gets worried that I may be stepping outside my practice boundaries liability-wise if I so much as verbally comment on bruises on a living person. Whether or not a person would go to jail over performing an autopsy without a medical license is something I do not know...but I would hate to be the poor sap facing the defense attorney in a case like that!

Mindy

 

[Mindy]

Agreed, the state has defined what an autopsy is and who OUGHT to perform it. But that is a far cry from defining in law who the ONLY practitioners of autopsies should be. That would require penalities for non-licensed MDs who perform "autopsies" which in my reading of the law (and I have law coursework under my belt...) are non-existent. Descretion of the dead is against the law...but this falls outside that definition.

Autopsies could even be considered part of protected burial ritual under the "Freedom of religion" and Im am unaware of any prosecution in the US for the last 100 years brought on wrongful post mortem examination.

The second issue is whether an autopsy is even an actual medical procedure...

LA -- I swear you are just a frustrated forensic pathologist at heart. They must NOT have taught you much about logic during your law training.

It is an autopsy if performed by a physician (p --> q),

then the contrapositive is also true:

It is not an autopsy if not performed by a physician (-p --> -q)

Did I now prove your arguments are illogical once and for all?




Mindy

 

[Ziehl-Neelsen]

LA -- I swear you are just a frustrated forensic pathologist at heart. They must NOT have taught you much about logic during your law training.

It is an autopsy if performed by a physician (p --> q),

then the contrapositive is also true:

It is not an autopsy if not performed by a physician (-p --> -q)

Did I now prove your arguments are illogical once and for all?




Mindy

Uh-oh. Mindy's bringing Wittgensteinian symbolic logic to bear on this thread. If anybody busts out with a Venn diagram, I'm out of here.

Question:
If Rosai is the omnipotent and omniscient pathologist, would it be possible for him to dream of a case so complicated that even he could not solve it?

 

[pseudoknot]

LA -- I swear you are just a frustrated forensic pathologist at heart. They must NOT have taught you much about logic during your law training.

It is an autopsy if performed by a physician (p --> q),

then the contrapositive is also true:

It is not an autopsy if not performed by a physician (-p --> -q)

The contrapositive negates and switches the statements, so p -> q would go to -q -> -p.

Your argument doesn't really make sense anyway though. You first statement claims that anything a physician does is an autopsy, presumably including driving to work and going to the bathroom.

 

[DarksideAllstar]

The contrapositive negates and switches the statements, so p -> q would go to -q -> -p.

Your argument doesn't really make sense anyway though. You first statement claims that anything a physician does is an autopsy, presumably including driving to work and going to the bathroom.

Logic BOO-YAH!

Man, its hot as hell here today.

 

[mlw03]

Logic BOO-YAH!

Man, its hot as hell here today.

aren't you in san fran, darkside? i thought it never gets hot there - highs in the 60s in july and such. yes, i know this is off-topic, but oh well.

 

[IcedTea]

Wow! How did I let this garbage thread slide by???!!!

Okay, lets clear up a few amazing lies:

1) I do the ENTIRE dissection, minus only the sawing of the calvarium, during an autopsy. NOBODY EVISCERATES MY CASES, BUT ME.

2) If the physicians who have responded that you do not need to be a doctor to perform an autopsy really believe it, I have to doubt their clinical skills. I will bet that they do not actually know how to properly eviscerate, maybe have never done so themselves. By the time I am done eviscerating (organ-by-organ), I have a working diagnosis. Cutting most of the organs just confirms I am not missing something (tumor, granuloma).

3) The term "diener" is really out of vogue, german for something like "man servant". Acceptable term is autopsy technician, though I am sure there are others.

4) 1-800-AUTOPSY is mostly an autopsy referral business with pathologists that are commissioned to perform autopsies arranged through the service. It is very successful.

5) Microscopy, toxicology, microbiology are FP staples.

6) My legal counsel gets worried that I may be stepping outside my practice boundaries liability-wise if I so much as verbally comment on bruises on a living person. Whether or not a person would go to jail over performing an autopsy without a medical license is something I do not know...but I would hate to be the poor sap facing the defense attorney in a case like that!

Mindy

This is weird....first you call my thread garbage then you clear everything up for me. lol. I guess I have nothing else to say but thank you 😀

Yeah I was surprised myself when it was said that autopsy techs aka dieners do most of the cutting. I thought the pathologists did that. But it seems like that is really the pathologist's job in performing an autopsy.

 

[Mindy]

Sorry Iced Tea:

It wasn't your initial posting I thought was garbage, it was the responses you got.

Mindy

 

[Mindy]

The contrapositive negates and switches the statements, so p -> q would go to -q -> -p.

Your argument doesn't really make sense anyway though. You first statement claims that anything a physician does is an autopsy, presumably including driving to work and going to the bathroom.

Ahh shucks, I've been out-logic-ed.

M

 

[DarksideAllstar]

aren't you in san fran, darkside? i thought it never gets hot there - highs in the 60s in july and such. yes, i know this is off-topic, but oh well.

Heat wave.... it was like 95 yesterday, 92 today. Its not that bad (I'm from Vegas and I've been through much worse, ie 122F July days) but since most the lab space is not air conditioned it becomes quite unbearable given that there has been absolutely no breeze off the ocean the past two days. Our summer months are actually May and September (warmest temperature wise and little/no fog). It looked like LA yesterday with all the ladies over in South beach wearing skimpy clothing...it made for a nice lunch hour.

BTW, thanks for the respite. This thread needed to be derailed. I'll try and post some pics of a cool case (read: bad for patient) that I had when I finish Step 3 on Wednesday.

 

[tardieu]

I am considering going into pathology in the future solely for autopsies. Here are my questions:

1) Can a general pathologist find a job to perform autopsies only or does he/she need to do fellowship training in forensic pathology to do autopsies only?

I'm asking because I know pathology includes a lot of examining specimens under a microscope and I'm not really interested in that; I mainly want to do autopsies.

2) Is a forensic pathologist the same as a medical examiner?

I know this is probably a really noobish question, but I've seen both these terms tossed around in various ways. I'm assuming yes, but I'm just asking to make sure.

If you like autopsies and examining gross pathology, forensics is for you. You may be able to find a job doing hospital cases, but you'd probably have to do something else too. A job doing only hospital cases would be rare. By contrast, you can't swing a dead cat without hitting a forensics job, especially if you're not overly picky about where you want to live.

Forensics is also for you if you have a broad range of interests, not just medicine and science, but, pretty much, almost anything else. If you like to learn about all kinds of things and incorporate that into your daily work, you can't do better than forensics.

The other part is stories; the culmination of an autopsy is the Opinion (or the Clinicopathologic Correlation, in hospital case), which is basically a story about what happed to the decedent. The story incorporates all the stuff you've discovered, through your work, your interpretations of it, and your best guesses. And, even though I know it sounds trite, but when it comes to forensics, the truth, or at least the glimpses of it you catch through your cases, really is stranger and much more fascinating and much more moving than fiction.

Don't count it out just because you're not enamored with microscopy. My guess is you probably haven't had any inspirational exposure. The topic can be very dry and detached. Say, when you do histo labs, you're just looking at slides; you have little if any context with the gross. When you do surgical pathology and autopsies, you MAKE the slides. You evaluate the gross specimen, interpret it, decide which sections to take, take them, look at them, then relate what you see directly back to the gross, which, ultimately, relates back to a real patient. Then you communicate your interpretation to a clinician, or in the case of forensics, a DA or law enforcement person, defense council, family member, etc, who will use your interpretation to make a decision about how to treat a patient, whether to prosecute or exonerate an accused, or to gain an understanding and perhaps begin the process of coming to terms with what happened to a loved one. It's a different ball game. It's your work, start to finish. It makes a difference. I think if you get a taste of that, you'll have a different opinion about looking at slides.

That said, slides are relatively minor, yet sometimes essential, part of forensics. So if you can make it through an AP residency (where, admittedly, slides are a major component), and you do forensics, your slide duties will be cake and your autopsies bread and butter.

 

[IcedTea]

Sorry Iced Tea:

It wasn't your initial posting I thought was garbage, it was the responses you got.

Mindy

Oh lol it's okay 👍

 

[IcedTea]

If you like autopsies and examining gross pathology, forensics is for you. You may be able to find a job doing hospital cases, but you'd probably have to do something else too. A job doing only hospital cases would be rare. By contrast, you can't swing a dead cat without hitting a forensics job, especially if you're not overly picky about where you want to live.

Forensics is also for you if you have a broad range of interests, not just medicine and science, but, pretty much, almost anything else. If you like to learn about all kinds of things and incorporate that into your daily work, you can't do better than forensics.

The other part is stories; the culmination of an autopsy is the Opinion (or the Clinicopathologic Correlation, in hospital case), which is basically a story about what happed to the decedent. The story incorporates all the stuff you've discovered, through your work, your interpretations of it, and your best guesses. And, even though I know it sounds trite, but when it comes to forensics, the truth, or at least the glimpses of it you catch through your cases, really is stranger and much more fascinating and much more moving than fiction.

Don't count it out just because you're not enamored with microscopy. My guess is you probably haven't had any inspirational exposure. The topic can be very dry and detached. Say, when you do histo labs, you're just looking at slides; you have little if any context with the gross. When you do surgical pathology and autopsies, you MAKE the slides. You evaluate the gross specimen, interpret it, decide which sections to take, take them, look at them, then relate what you see directly back to the gross, which, ultimately, relates back to a real patient. Then you communicate your interpretation to a clinician, or in the case of forensics, a DA or law enforcement person, defense council, family member, etc, who will use your interpretation to make a decision about how to treat a patient, whether to prosecute or exonerate an accused, or to gain an understanding and perhaps begin the process of coming to terms with what happened to a loved one. It's a different ball game. It's your work, start to finish. It makes a difference. I think if you get a taste of that, you'll have a different opinion about looking at slides.

That said, slides are relatively minor, yet sometimes essential, part of forensics. So if you can make it through an AP residency (where, admittedly, slides are a major component), and you do forensics, your slide duties will be cake and your autopsies bread and butter.

Excellent response, thanks man 👍

 

[KCShaw]

Alas, if the world of medicine was completely logical then we would have considerably less use for EBM.

If the law (and enforcement of it) complied with recommendations from national organizations such as NAME when it comes to forensic pathologic examinations, then I suspect we wouldn't have "expert" testimony claiming that a particular gunshot wound indicated two pairs of hands were on the gun that fired the fatal bullet. But it doesn't, and we do.

The lack of a billing code for an autopsy doesn't preclude people charging for it or getting paid for it -- just limits the options. But it has certainly damaged the average pathologist's interest in "performing" autopsies, and subsequently training in performing them (at least at some institutions). I think the average pathologist hasn't fought against this because, frankly, most feel they have quite enough business with oncologic surgical pathology as it is. Convincing someone to fight for something that takes a lot of time and has a relatively high risk of involving a lawyer isn't that easy when they're already working 10 hr days.

Folks have batted around deiner/morgue tech quite a bit in this thread, but I haven't seen anyone mention "pathologist's assistant." Though the average PA job is focused on grossing (taking surgical specimens, examining/describing them macroscopically, and cutting in samples for microscopic examination by a pathologist) they are also trained in basic morgue tech duties and a few PA jobs are geared towards this. Two year training program, by the way. But that's for the masses who escaped medical school.

At any rate -- if you're not sure about the whole pathology/autopsy deal, spend some time rotating in pathology. Getting involved is, IMO, the best way to gauge whether it's your thing, though unfortunately most medical schools don't dedicate time *in* pathology despite the widespread reliance on pathology (be it clinical or surgical) for definitive diagnoses. I.e., you'll probably have to burn an elective or some vacation time on it, but it's worth it if it helps you make a decision.