Autopsy, Anatomical Pathology
The Division of Autopsy provides services for Northwestern Memorial Hospital. Approximately 200
postmortem examinations are performed per year.
An actual courtroom question
Q: Doctor, how many autopsies have you performed on dead people?
A: All my autopsies are performed on dead people.
With today’s modern technology laden medicine, some people ask;
Why do autopsies? There are several excellent reasons to obtain
an autopsy on all deaths. The autopsy is the gold standard
for confirming clinical diagnoses and determining the cause of death. It
is also the best method for assessing the efficacy of treatment. As
a research tool, it is able to contribute greatly to our understanding
of the pathogenesis of disease. Even in modern times the autopsy
is still able to identify new diseases. An example being AIDS
encephalopathy. Finally, the autopsy is an important contributor
to the training and education of medical students, residents, fellows,
and laboratory technologists. Some benefits of the autopsy
are listed below.
Answers questions
- Assists in resolving grief and guilt
- Helps in settling insurance claims
- Helps identify familial disorders
- Helps to identify environmental/occupational hazards
- Helps to identify trends in infectious diseases
- Improves the accuracy of vital statistics
- Helps insure quality of medical care
- Furthers medical education
- Furthers medical research
- Serves as quality control within the medical specialty of pathology
- Verifies second opinion consultations
- Provides legal documentation of findings
Is it really necessary?
Numerous recent studies have confirmed the importance of the autopsy. Autopsies continue to detect clinically important diagnostic discrepancies,
according to a new evidence report from AHRQ's Evidence-based Practice
Center at the University of California at San Francisco-Stanford University. Based on an analysis of more than 50 studies spanning 40 years, researchers
estimate that, in U.S. hospitals in the year 2000, the correct cause
of death escaped clinical detection in between 8 percent and 23 percent
of cases, with as many as 4 percent to 8 percent of all deaths having
a diagnostic discrepancy that may have harmed the patient. In addition
to clinically missed diagnoses, up to 5 percent of autopsies disclosed
clinically unsuspected complications of care. The diagnostic discrepancies
sometimes represent medical errors, but more commonly represent acceptable
limits to current medical technology or the occurrence of atypical clinical
presentations. Autopsy findings can play a major role in improving clinical
performance.
Teaching
Two pathology residents per month rotate through the service. During this
time, they focus on the clinicopathologic aspects of each individual case
and perfect their prosection skills. When their training has been completed,
they have assumed responsibility for and participated in more than 75
autopsy cases.
Who would do an autopsy? Are they professional people?
At Northwestern Memorial Hospital, autopsies are performed by pathology
residents and faculty with the assistance of a trained autopsy technician
termed a diener. Autopsies are performed every day of the year. The resident,
faculty and diener team is on call 24 hours a day, 365 days a year.
Where is an autopsy done?
Medical Examiners cases are done at the ME's Office. All other
cases are performed at Northwestern Memorial Hospital's autopsy suite. The autopsy suite closely resembles
an operating suite. The state-of-the-art suite at Northwestern consists
of a clean anteroom with protective gear and a place to do paper work,
both male and female locker rooms with shower facilities, and an ample
dissection suite with two autopsy tables. An automatic camera and stand
is present in the suite for photographing gross organs. A dissection microscope
with camera is present for small specimens and a 35mm camera with ring
flash is available for in situ photography. A separate but adjacent office
houses the Division’s assistant, a photocopier, large format printer
for poster presentations, multi-headed microscope for signouts, computer
workstation, and resident work area. Also adjacent is the Department’s
multimedia laboratory. This lab is staffed with a fulltime experienced
photographer and various pieces of equipment including a Vanox motorized
photomicroscope outfitted with a high resolution digital camera, 35mm
cameras, and a single large format camera back.
A number of didactic sessions are scheduled on a regular basis:
- Department of Pathology Weekly Autopsy Conference, Wednesday 7:30
a.m. Autopsy suite Olson 3-525
- Monthly Conferences with the Department of Medicine are held the last
Friday of the month at 12 noon in the Medicine Conference room, Feinberg
13 floor.
Faculty
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