By Sharon Mount | Contributor
Popular television shows such as CSI have helped familiarize nonmedical folks about the role of pathologists (often female and good looking on TV) as well as characteristics of the morgue. While some of the information gleaned from these shows is quite true (actually one of our autopsy technicians was the recent Miss Vermont), stereotypes such as spooky morgues located at the end of dark hallways in the basement are certainly not the case in the State of Vermont.
The history of the autopsy parallels the interest in human anatomy, beginning in ancient Greece and Alexandria and then experiencing a renewal in the Renaissance. It culminated in the work of Andreas Vesalius, who lived from 1514 to 1564, and whose work, De humani corporis fabrica (On the Fabric of the Human Body) is widely considered the foundation of modern human anatomy. It was the Renaissance anatomists who developed the idea of a disease being localized to a specific organ and, hence, the usefulness of the autopsy.
The autopsy was once valued as a critical component of quality control. Hospitals were rated as to the number of autopsies performed. Rates in the U.S. and Europe were as high as 60 percent in the 1950s. In 1971, however, the Joint Commission on Accreditation of Hospitals stopped requiring hospitals to perform autopsies, and in 1986 Medicare stopped paying for them. The rate of autopsy began to plummet and now in many hospitals is less than 5 percent.
This decrease has been attributed to many factors, including religious and social objections, economic considerations and fear of medico-legal implications. There has also been a notion that, in this era of high-tech medicine, the autopsy has become obsolete. This, however, is not the case. Recent publications have demonstrated that major discrepancies are found between clinical diagnoses and postmortem findings in 10 to 23 percent of patients and that minor discrepancies are found in up to 40 percent of patients.
It was Governor Howard Dean who supported building a state of the art morgue located at the FAHC campus of the UVM Medical Center in Burlington. It is a modern facility complete with skylights, not a dark basement as portrayed on TV! There are two separate rooms, one for medical examiner (ME)/ forensic cases and one for hospital autopsies.
The missions of the ME and the hospital autopsy faculty are both different and similar.
The ME mission, stated simply, is to protect our safety. Staffed by two pathologists, a detective, an assistant ME coordinator, field MEs, autopsy technicians and administrative staff, this office reviews every death in the state to determine whether the death was natural, accidental, a suicide or a homicide. MEs have the legal authority to perform an autopsy if necessary to understand better the cause of death or to provide trial evidence. Last year over 400 ME autopsies were performed. We are most fortunate that our MEs are also very gifted educators who teach undergraduates, medical students and residents. The strength of their mentoring is evidenced in the large percentage of our pathology residents who pursue fellowship training in forensic pathology.
The mission of the hospital autopsy service is to investigate complicated clinical cases and provide answers to questions that have arisen during the patient’s clinical course. Approximately 120 hospital autopsies were performed last year. Sometimes genetic diseases that can impact family members are discovered. As well as serving as a gold standard for quality control, the autopsy service is strongly committed to the education of clinicians, residents in training and medical students. The service also supports investigators whose research involves the study of human tissue. One only has to see the recent movie Concussion to understand the vital role of the pathologist (in this case, neuropathologist) in understanding disease.
Both the medical examiner and hospital autopsy services are similar in that they can help grieving families. Having a better understanding of the cause of death of a loved one can help bring closure and acceptance. This was true in the case of my beloved father-in-law, whose cause of death was known heart disease. Understanding the severity of his disease revealed at autopsy, however, brought an appreciation of how fortunate we were to have had him in our lives for the time we did.
The autopsy procedure is performed with the same meticulous care as surgeries performed in the operating room. Dedicated pathologists, residents and autopsy technicians consider the deceased to be our patient and are respectful and grateful for the teaching opportunity each autopsy provides. After an autopsy, the body is released to the funeral directors with no compromise should an open casket ceremony be desired.