I liked the post upthread where the person mentioned it’s the MANAGEMENT of chronic disease that really shows up at the postmortem.
If the family doctor could indeed crack open a patient’s chest, pull out the heart, and stick it under the patient’s nose, there probably would be a MUCH greater compliance by the patients in taking medication, eating correctly, and getting exercise.
For the most part, people with high blood pressure don’t “feel” the need to take all those stinkin’ pills, so they sit in a drawer someplace. When Grandma finally drops dead at the Thanksgiving dinner table, it’s the pathologist who pulls out the scarred, enlarged heart and said, “This lady missed out on watching her grandkids grow up because she didn’t take her medicine.”
Oftentimes, the correct information is THERE. It’s what people DO with the information that makes all the difference.
~VOW
Granted, that does happen, but I second what Jackmanii said, even if I work in a related field (animal vs human medicine).
And again, it is important to different the subset of pathologists that specialize in forensics with the majority that reads biopsies. Even I as a veterinary pathologist read a fair amount of biopsies. Those are important in diagnosing tumors. It is with what they say that other physicians look at the info and start treatment. If that pathologist is wrong, a whole unnecessary treatment is started, which benefits no one.
One thing I will add is that pathology did seem to attract the most of the smartest (in the doing well in the classes smart kind of way) of the medical students in our class. Not sure if that would have translated to being good clinical diagnosticians or an ability to manage cases well, but still, a pretty impressive group.
Is he sure about that? Maybe some clinical correlation is required.
One of the common scenarios for a hospital autopsy is the chronically ill patient with what are euphemistically known as “multiple co-morbidities”.
We get a request to do a post on a 78-year-old man with a 60-pack-year smoking history, type II diabetes, hypertension, emphysema, coronary artery disease, peripheral vascular disease, chronic renal failure, on a list of meds as long as your arm, who codes during his sixth hospital admission in the past year, and the family wants to know why Dad died “unexpectedly”.
There are so many possibilities for what killed him, it gets difficult to pick the right one.
I’ve never worked in pathology, but I’ve worked with others who did. One day, we were in the break room eating lunch and swapping war stories. One of my co-workers told us that her old employer did a lot of autopsies requested by families looking for evidence to support wrongful death claims against former employers. Those paid the bills, but trying to figure out what to code and how to code it was a nightmare for her, so she left pathology to work in the glamorous field of oncology.
And then there was the decedent I encountered at the VA. Seems his family was under the impression that Dad had had some device implanted in his arm during his service in Korea, and the family wanted to know what the device was, what it was for, and could they have it? The x-rays showed nothing except normal anatomy, and the radiologist noted there wasn’t even a scar on the skin. The pathologist talked to one of the patient’s children, who confirmed that Dad had been joking. (He’d been in my unit when he died, and I got to read some of this when I put his chart together for final disposition. You could hear the doctors’ eye-rolls on paper.)
