Abstract
When one thinks of the role of the Forensic Pathologist the first thing that usually comes to mind is doing an autopsy. Derived from the Greek “to see for oneself” the term autopsy is most commonly used to refer to an external and internal inspection and examination of a body after death. The primary role of the Forensic Pathologist, however, is not to do the autopsy, but to determine the cause and manner of death; the autopsy is the most valuable tool available to help make those determinations. (This is somewhat different from the clinical, or hospital-based, autopsy which usually focuses more on medical management and the efficacy of patient therapy.) The quality of the Death Certificate and the value of all proceedings based on that document are most often determined by the quality of the autopsy. Improving the quality of the autopsy will therefore improve the functioning of the forensic pathologist. How fitting then that the inaugural issue of this journal, the official publication of the National Association of Medical Examiners (NAME) is dedicated to the autopsy and how its performance may be improved.
Besides the “inspection and examination” of the cadaver, which is “seen by oneself” there are other “ancillary tests and services” (as defined in NAME's Forensic Autopsy Performance Standards) such as histology, radiology, toxicology, microbiology, perhaps neuropathology, and other forensic consultants that are often utilized before the forensic pathologist makes a final determination. Some might take the broad definition and include all of these entities as part of the autopsy (they do become part of the autopsy report); and others might take a more narrow view that they are not technically part of the autopsy proper, because the findings are usually attached as addenda and are often not seen by oneself. Regardless of what they are called, all components of the death investigation must always be consistent with, never inconsistent with, and capable of contributing to the forensic pathologists’ ability to answer the relevant questions surrounding the death and to certify it. This is the ultimate purpose of doing the forensic autopsy. The working definition of autopsy here will include all elements of the investigation that forensic pathologists utilize to achieve that goal.
Not discussed in this issue are any specific techniques of improving prosection. Unquestionably, the autopsy will benefit from better methods of demonstrating findings, documenting them, and even preserving and presenting them. Perhaps a future issue may address those topics. Here we will focus on how to get a better yield of information from the otherwise “routine” autopsy. Toxicology, microbiology, and histology – their utility in general, what is or should be “routine” and when to do that “just one more” test. Of equal importance, when might it be more efficient to not do the routine testing? Virtual microscopy – can, or should, it become a regular tool for all forensic pathologists? And if so, when is its use appropriate and what are the limitations? Quality assurance is a topic rarely raised by Forensic Pathologists who practice outside of academic or clinical settings. Now that Maintenance of Forensic Pathology Board Certification will require documentation of performance in practice it becomes imperative to take this more seriously. Setting up protocols for maintaining and improving the autopsy work product will prevent the forensic pathologist who does thousands of autopsies from repeating one autopsy thousands of times.
So sit back and enjoy reading this issue. Think how each paper might affect the way you do your cases and think how to utilize the authors’ suggestions in your practice. Each autopsy that benefits from improvement contributes to the validity of the autopsy in general. The forensic community and the people we serve deserve no less than the highest quality products that we as Forensic Pathologists can produce.
With gratitude for the opportunity to make my contributions and most respectfully,
