Forensic Pathology

Ed Uthman, MD

Diplomate, American Board of Pathology

Revised 17 Oct 1998

I. Introduction

Forensic pathology, which for practical purposes deals with the postmortem investigation of sudden and unexpected death, is about as far from the mainstream of medicine as one can get, short of actually becoming Surgeon General or a medical school dean. The training of a forensic pathologist generally entails a complete five-year residency in anatomic and clinical pathology, followed by one or more years of fellowship training in a medical examiner's office in a large city "fortunate" enough to have hundreds of homicides per year. A completely credentialed forensic pathologist is certified by the American Board of Pathology as both a general pathologist and as a subspecialist, following successful completion of the Board examinations in anatomic, clinical, and forensic pathology. For information on how to become a forensic pathologist, see Forensic Pathology Careers: Frequently-Asked Questions.

The good forensic pathologist is an amalgamation of pathologist, detective, politician, and public relations person. Not only must one know the technical aspect of the discipline, but he/she needs to have the communication skills to acquire supportive information from law enforcement officers and explain the results of medical examinations to juries (which are specifically selected for technical ignorance) and other laypeople. Also, mediocre media operatives, desperate for exposees when news is slow, find medical examiners to be quick and easy targets. Forensic pathology, because it involves no mean amount of educated guessing, lends itself well to glib Monday morning quarterbacking by amateurs.

[There are a few peculiar incidental advantages to being in the world of forensic pathology. 1) In many jurisdictions, the forensic pathologist, as a criminal investigator, may acquire a permit to carry a handgun. This is perfect for those just macho enough to wish to go armed, but not so macho as to want to go to jail for it. 2) Since forensic pathologists typically work in nonmedical institutions, such as city morgues and county medical examiner's offices, they may be exempt from licensing/certifying agencies and may thumb their noses at even the most basic laboratory safety practices. It is something of a tradition for a lot of eating and smoking to be going on while actually performing autopsies. On the other hand, forensic pathologists are not known for their longevity]

II. Role of the Forensic Pathologist

Forensic determinations go beyond those of patient-oriented medicine, as they involve legal as well as medical considerations:

A. Cause of death

This is a specific medical diagnosis denoting a disease or injury (e.g., myocardial infarction, strangulation, gunshot wound). In particular,

B. Mechanism of death

This term describes the altered physiology by which a disease or injury produces death (e.g., arrhythmia, hypoventilatory hypoxia, exsanguination).

C. Manner of death

This determination deals with the legal implications superimposed on biological cause and mechanism of death:

III. "Normal" postmortem changes

These are important to be familiar with, as they may otherwise mislead the examiner into thinking trauma or other foul play led to the victim's death.

IV. Trauma

This is the cornerstone of forensic pathology. Terms used to describe traumatic lesions are somewhat more specific than analogous terms used in surgery and internal medicine.

V. Death by Natural Causes

Perhaps having a bit more relevance to patient-oriented medicine is the problem of sudden and unexplained death by natural causes. Careful attention to the autopsy and the patient's history usually establish the cause of death, but a few cases, like that of Elvis Presley, will remain mysteries indefinitely.

DISCLAIMER

This article is provided "as is" without any express or implied warranties.

While every effort has been taken to ensure the accuracy of the information, the author assumes no responsibility for errors or omissions, or for damages resulting from use of the information herein.

Copyright (c) 1995, Edward O. Uthman. This material may be reformatted and/or freely distributed via online services or other media, as long as it is not substantively altered. Authors, educators, and others are welcome to use any ideas presented herein, but I would ask for acknowledgment in any published work derived therefrom. Commercial use is not allowed without the prior written consent of the author.

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