Preliminary Autopsy Diagnosis

[throwawayacct1284749]

Anyone here have any resources or advice on how to construct a PAD?

I just started autopsy rotation and I've written 1 PAD so far (was critiqued and re-written by the autopsy director).

Generally speaking I know one is supposed to list by organ system, in the format: process, site, then organ. Although there are exceptions to this.

Any advice or resources would be greatly appreciated!

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[univlad]

I would just follow your department's protocol and take the advice of the autopsy director. I think it's very location dependent.

For residency, I would list them in the order of most significant and try group related processes together, but that is how our attending preferred it. The list could be quite long sometimes, including minor insignificant findings.

In private practice when my group still did autopsies, I would basically just issue PAD with a couple major or negative findings listed and comment addressing the main question to get something into the chart so people wouldn't call and bother me asking when the report would be done. Then I'd add a comment saying a final report will be issued in 30 to 60 business days once additional testing and histology slides have been reviewed. Then after a few weeks, I'd sign out the report late on a Friday and hope it went unnoticed.

 

[BU Pathology]

It is important to remember who will use the information, the clinicians who cared for the patient and the family. It is usually best to answer the major questions first, especially if there are negative findings. For sudden deaths a typical question is the presence of a PE, so that should be in the PAD and will not change with microscopic examination. Think of the PAD in this way, if this were my next-of-kin what information would I like to know from the autopsy. As mentioned, grouping diagnoses helps to organize the report in a more succinct manner.

Daniel Remick

 

[shikimate]

I do a quick summary, then list by organ system, start with most relevant. I give an example below but this is not what I was taught in residency. I dislike the format I learnt in residency,

Standard external and internal examination (including the CNS) was performed on this 60 year old male who collapsed during a drunken reverie. The history is notable for a lifetime commitment to debauchery and dissolution. The main gross findings are:

1) Cardiovascular System:
- severe stenosis of the...
- old scar/infarct in the...
- cardiomegaly...

2) Respiratory System:
- bullae and anthracosis, consistent with COPD and history of...

3) Gastrointestinal System:
- nodular liver, consistent with cirrhosis...

4) Pending Investigations:
- toxicology...
- etc.

 

[LADoc00]

insider tip: grab old reports at your program, copy them, rinse repeat.

medical autopsies are comical, no one pays for them, they can only get you into trouble and they take forever to complete.

I lost at least 2 GFs in residency when I was forced the delay important dates due to autopsy write ups...what a waste.

Society attaches a dollar amount to services it values and society has attached a ZERO dollar amount to autopsies.

 

[HeyDalaron]

insider tip: grab old reports at your program, copy them, rinse repeat.

medical autopsies are comical, no one pays for them, they can only get you into trouble and they take forever to complete.

I lost at least 2 GFs in residency when I was forced the delay important dates due to autopsy write ups...what a waste.

Society attaches a dollar amount to services it values and society has attached a ZERO dollar amount to autopsies.

For those of you who practice at hospitals where autopsies are done, have you tried to convince the clinical staff to never ask for them?

I can't find any justification for doing a hospital autopsy. It takes up time and resources that could be put to use in a better way, which is every other way.

 

[shikimate]

some families are willing to pay for hospital autopsy though.
sometimes it's fun to prove clinicians wrong, like when 2 cardiologists poke around the atrium looking for an opening they thought existed on bubble studies...