Autopsy standard

[deleted314957]

The G.D CAP has advocated to reinstate the autopsy requirement at the AMA meeting. THAT is how they are spending their time and money. Perhaps it could be applicable to hospitals with path residencies but I sure as hell didn’t have the time or interest to do them when I was in practice ina community setting and I suspect most of y’all don’t either.

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[y2k_free_radical]

The G.D CAP has advocated to reinstate the autopsy requirement at the AMA meeting. THAT is how they are spending their time and money. Perhaps it could be applicable to hospitals with path residencies but I sure as hell didn’t have the time or interest to do them when I was in practice ina community setting and I suspect most of y’all don’t either.

I am not paid a fair amount for being LAB DIRECTOR now and any increase in hospital autopsies will not lead to any increased compensation in most community hospitals.

 

[pathslides]

The G.D CAP has advocated to reinstate the autopsy requirement at the AMA meeting. THAT is how they are spending their time and money. Perhaps it could be applicable to hospitals with path residencies but I sure as hell didn’t have the time or interest to do them when I was in practice ina community setting and I suspect most of y’all don’t either.

please elaborate. What is the autopsy requirement post residency ?

 

[y2k_free_radical]

please elaborate. What is the autopsy requirement post residency ?

At one time ACADEMIC hospitals had to autopsy up to 50% and community hospitals up to 25% of deaths for accreditation i believe.

 

[pathslides]

At one time ACADEMIC hospitals had to autopsy up to 50% and community hospitals up to 25% of deaths for accreditation i believe.

my gosh, how stupid. CAP has become utterly useless with such garbage leadership.

 

[Med Director New England]

This will go no where. Most community hospitals can not afford to outfit an autopsy suite and / or pay for deiner services, even some academic centers are struggling with this. Any one here still able to eviserate the organs and remove a brain without mutilating the deceased?

advanced imaging and better ante-mortem diagnostics are making the hospital autopsy obsolete anyway.

 

[Med Director New England]

Here is the link

October 1, 2019

The College of American Pathologists is the world's leading organization of board-certified pathologists.

www.cap.org

The last sentence of Paragraph 2 is laughable.

 

[y2k_free_radical]

This will go no where. Most community hospitals can not afford to outfit an autopsy suite and / or pay for deiner services, even some academic centers are struggling with this. Any one here still able to eviserate the organs and remove a brain without mutilating the externa?

advanced imaging and better ante-mortem diagnostics are making the hospital autopsy obsolete anyway.

Hate to admit it, but i still often find unexpected significant pathology in spite of advanced diagnostics in the autopsies i perform.

 

[Alteran]

This is what happens when academics set the agenda for us all. It will go no where.

May I humbly suggest to CAP that instead of wasting their time with making sure we all have continued autopsy experiences, they should instead work to improve the overall quality of education in pathology training programs....among many other actually relevant issues. Seems like a more fruitful effort if you ask me.

 

[Med Director New England]

Hate to admit it, but i still often find unexpected significant pathology in spite of advanced diagnostics in the autopsies i perform.

No doubt - I agree we often find something unknown but would argue there is really no added value in hospital autopsies. I imagine most final autopsy reports are at best skimmed by our clinical colleagues.

The CAP claim on the potential impact of the decline of the autopsy — and to quote them the impact would have a “detrimental impact on public health” is laughable. CMS had smart folks investigate this. They determined the resources arebetter used elsewhere. The value of pathology to the medical community is not the autopsy, hasn’t been that way for a while.

 

[deleted314957]

“Autopsies” in the community hospital setting should be “problem” focused to answer one (perhaps two) questions. I would then (or have the P.A.) do a large core bx of the liver or get an “open” bx chunk for example or whip out the heart or open a main pulmonary artery. Lots of in-situ stuff. You get the idea. There was no more evisceration, mess, hauling bodies etc. Ibasically told the clinicians this is what you get and everyone seemed happy. Even this became a rarity as my practice wound down.

 

[octopusprime]

I agree, Mike, with the "focused" approach to exams. While I don't give the CAP credit for much of anything, perhaps the intent may be more along the lines of maintaining in-house services and not helping to incentivize pathology outsourcing? Maybe that's not the reasoning of their position and it's more of an academic vestige, but it is perhaps one less bullet in the magazine for the proverbial execution when hospitals line up their PP groups for the firing squad... We perform a small number of autopsies for our hospitals annually...maybe i'm kidding myself that it's another service we can provide the system that would otherwise be an expense were the system to bring in a national lab outfit, but it's not hurting me to have this policy.

 

[HeyDalaron]

Money does not grow on trees. I'm pleased CMS has made the pragmatic decision regarding this antiquated ritual practice.

 

[Dave CX]

“Autopsies” in the community hospital setting should be “problem” focused to answer one (perhaps two) questions. I would then (or have the P.A.) do a large core bx of the liver or get an “open” bx chunk for example or whip out the heart or open a main pulmonary artery. Lots of in-situ stuff. You get the idea. There was no more evisceration, mess, hauling bodies etc. Ibasically told the clinicians this is what you get and everyone seemed happy. Even this became a rarity as my practice wound down.

I was the grand master blackbelt of the minimally invasive autopsy!!!

 

[ScubaV]

I wonder what is CAP's motivation here? Is it a misguided attempt to fight for pathologists (misguided in that I'm sure a majority would rather never do another autopsy, especially since they're rarely compensated)? Or is it being led by one of those nostalgic old school guys like the one lamenting who will do his autopsy?

To me, non-forensic autopsies are obsolete. Even in the case of unexpected findings, how often are those actionable in some way? I can see some value in select, targeted autopsies, but doing unlimited ones as a matter of course or to maintain accreditation outside of residency is ridiculous and a giant waste of resources.

 

[y2k_free_radical]

I wonder what is CAP's motivation here? Is it a misguided attempt to fight for pathologists (misguided in that I'm sure a majority would rather never do another autopsy, especially since they're rarely compensated)? Or is it being led by one of those nostalgic old school guys like the one lamenting who will do his autopsy?

To me, non-forensic autopsies are obsolete. Even in the case of unexpected findings, how often are those actionable in some way? I can see some value in select, targeted autopsies, but doing unlimited ones as a matter of course or to maintain accreditation outside of residency is ridiculous and a giant waste of resources.

Not to sound like a CAP cheerleader, but i must confess that i have found many significant unexpected findings not discerned or correctly interpreted by other diagnostic means.However,i know that my hospital would not fairly compensate me,if at all, for additional autopsies since it is obvious how little they value me being the LABORATORY MEDICAL DIRECTOR.The CAP is ignorantly or willfully out of touch concerning community pathology.

 

[Med Director New England]

We all find stuff not known ante-Mortem
but I only remember one finding in the couple of hundred autopsies that I have done that really impacted living relatives of the deceased. This particular case was in residency (at a huge academic center) and would be extremely unlikely to happen at a smaller place. Also the targeted autopsy would have missed it....

I think CAPs motivations are to protect the pathologist at the smaller hospital but this is mid-guided IMO. CAP if you want to help — encourage residency slots to match demand of good applicants and availability of jobs.

Forced autopsy services in theory increases need for pathology services. Hospitals resist b/c they don’t see much value & pathologists resist b/c it is for the most part lost time with no add comp. Interesting that jobs posting report no autopsies as a pertinent negative while CAP continues to push the autopsy. Complete disconnect in our field.

 

[Iceman24]

We all find stuff not known ante-Mortem
but I only remember one finding in the couple of hundred autopsies that I have done that really impacted living relatives of the deceased. This particular case was in residency (at a huge academic center) and would be extremely unlikely to happen at a smaller place. Also the targeted autopsy would have missed it....

I think CAPs motivations are to protect the pathologist at the smaller hospital but this is mid-guided IMO. CAP if you want to help — encourage residency slots to match demand of good applicants and availability of jobs.

Forced autopsy services in theory increases need for pathology services. Hospitals resist b/c they don’t see much value & pathologists resist b/c it is for the most part lost time with no add comp. Interesting that jobs posting report no autopsies as a pertinent negative while CAP continues to push the autopsy. Complete disconnect in our field.

Can't agree more.
However, the fact that some hospital services are not bringing money can not be a single solid argument to shut down the service, right? For instance, blood bank is a good example (if we do have BB guys around please correct me if I'm wrong). But let's combine financial disadvantages with abundance of fancy imaging techniques, micro invasive/laparoscopic surgeries, biopsies, and diagnostic tests, and the reason dead men service is facing extinction is quite clear.

From my point of view what is happening is that CAP is desperately trying to Make Pathology Great Again but the way it is done makes me think about good old "Idiocracy" movie, over and over again. They are not even trying to implement any policies for programs accreditation to reflect the number of surgicals, paps, frozens, (simply because such an implementation will lead to immediate shutdown of significant number of programs, 10 to 30%, I'd guesstimate) etc, but instead keep pushing for "magic number" of 50 autopsies. What happened in real life now days is residents just making these numbers up sharing the autopsies or simply falsifying the records because nobody gives a ****, especially program directors.

I have a vague recollection when the chair of the department where I did my residency was bragging how he "protected" the number of residency slots in the program. At some point the hospital administration called him over and suggested to reduce the number of residents (something like from 16 to 12 total). He argued that there are so many highly reputable programs in the country which have much less surgicals and much more residents, he supplied this statement with some numbers and pressure was relieved then. "Cheap labor" argument is not applicable in this case since we have enough PA's. Hell no, more then enough.

 

[y2k_free_radical]

We all find stuff not known ante-Mortem
but I only remember one finding in the couple of hundred autopsies that I have done that really impacted living relatives of the deceased. This particular case was in residency (at a huge academic center) and would be extremely unlikely to happen at a smaller place. Also the targeted autopsy would have missed it....

I think CAPs motivations are to protect the pathologist at the smaller hospital but this is mid-guided IMO. CAP if you want to help — encourage residency slots to match demand of good applicants and availability of jobs.

Forced autopsy services in theory increases need for pathology services. Hospitals resist b/c they don’t see much value & pathologists resist b/c it is for the most part lost time with no add comp. Interesting that jobs posting report no autopsies as a pertinent negative while CAP continues to push the autopsy. Complete disconnect in our field.

While i probably have a skewed sample,my experiences have been different in finding unsuspected,undetected or misdiagnosed significant disease entities or causes of death in a number of cases.

 

[WEBB PINKERTON]

God dude, you went back and found some post on Histonet from 2011? Nice work. Back away from your computer and get out more.

 

[path24]

Pathology "Leadership" hard at work. Wow. They should go back to seeing if any insurance company will return their calls. (crossing fingers they don't get laughed out of the room again)

 

[mestielest]

In Turkey most pathology programs never carry out an autopsy. Some residents are carrying out one or two forensic autopsies in forensic rotations.