MHD - Lecture 20 - The Autopsy

Question 1

What is an autopsy?

Where is it performed?

Who gives consent?

Answer 1

Autopsy = post-mortem examination
Medical vs Forensic Autopsy

2. Performed in hospitals
3. Consent must be obtained from next of kin
   Prioritized list of relationships on consent form
   External exam, internal examination of organ, histologic study of sections
   Clinico-pathologic correlation

Question 2

Where is the forensic autopsy performed?

What are some reasons a forensic autopsy would be performed?

Answer 2

Performed in Medical Examiner’s office, forensic pathologist

“Medical Examiner Cases”

-Violent deaths:
-Suicide, accident, criminal violence
Deaths less than 24 hours of hospital admission
Deaths of “healthy” individuals, unexpected deaths
Deaths during diagnostic/therapeutic procedures
Deaths within 24 hours of anesthesia
All deaths due to burns
Deaths where addiction to drugs/alcohol may have contributed to death
Dead on arrival to emergency department

Question 3

In the latter half of the 20th century, medical autopsy rate in the US declined
Why?

Answer 3

Request less
More confidence in modern diagnostic techniques
- Clinician discomfort with making request of grieving family
- Culture of medicine which does not dwell on “failures”
- Fear of results increasing malpractice cases
- Dissatisfaction with timeliness and/or quality of autopsy reports
- More patients with chronic disease dying outside hospital

Question 4

Why would the family request an autopsy less?

Answer 4

1. not informed of value
2. Being charged for autopsy (usually free)
3. Delays in funeral arrangements
4. Worry about disfigurement of deceased (autopsy does NOT distort the body)

Question 5

What did the pathologists experience?

Answer 5

Face increased demands on their time
As new lab tests were developed, the role of clinical pathology grew
More surgical specimens from operations and endoscopies dominate pathologists’ time
Greater focus on research

Question 6

What are the benefits of autopsys?

Answer 6

1. Establish final diagnoses, diagnose unsuspected disease
2. Evaluate accuracy of pre-mortem diagnoses, results of treatment
3. When possible, determine cause of death
4. Opportunity for clinicians to correlate lab, physical findings with pathologic changes of disease
5. Quality assurance, quality improvement

Question 7

The following are examples of what:

Identification of congenital or infectious disease
Help eliminate belief that they contributed to death
Provide comfort by providing cause of death
Provides accurate data for benefits, worker’s comp
Some families are consoled by thought of contributing to medical advancement

Answer 7

Families positive role in autopsys

Question 8

Why is the public important in autopsys?

Answer 8

1. Health surveillance

2. 87 new diseases identified or clarified through post-mortem examinations

Question 9

How do medical students play a role?

Answer 9

Reinforce concepts in anatomy, histology, and pathology for students and residents

Opportunity to integrate clinical knowledge with pathologic findings

Provides tissue for research

Source of images