FORENSIC PATHOLOGY

Forensic pathology: Forensic pathology is a branch of medicine concerned with determining cause of death, usually for criminal law cases and civil law cases in some jurisdictions. The word forensics is derived from the Latin forēnsis meaning public or forum. The word pathology literally means study of suffering.

Scope of Forensic Pathology

The Forensic pathologist:

Is a medical doctor who has completed training in anatomical pathology and who has subsequently sub-specialized in forensic pathology. 'Fully qualified' forensic pathologists are individuals who have completed their pathology residency and forensic pathology fellowship and have passed the "board" examination administered by The American Board of Pathology ("board-certified") (United States) or who are eligible for inclusion on the specialist register of the General Medical Council (GMC) having obtained Membership of the Royal College of Pathologists (United Kingdom).
Performs autopsies/ post mortem examinations to determine the cause of death (the pathologic process, injury, or disease that directly results in or initiates a series of events which lead to a person's death, such as a bullet wound to the head, exsanguination due to a stab wound, manual or ligature strangulation, myocardial infarction due to coronary artery disease, etc.) and (in the USA) the 'manner of death' (the circumstances surrounding the cause of death, which in most jurisdictions include homicide, accident, natural, suicide and undetermined). The autopsy also provides an opportunity for other issues raised by the death to be addressed, such as the collection of trace evidence or determining the identity of the deceased.
Examines and documents wounds and injuries, both at autopsy and occasionally in a clinical setting.
Collects and examines tissue specimens under the microscope (histology) in order to identify the presence or absence of natural disease and other microscopic findings such as Asbestos bodies in the lungs or gunpowder particles around a gunshot wound.
Collects and interprets toxicological analyses on bodily tissues and fluids to determine the chemical cause of accidental overdoses or deliberate poisonings.
Forensic pathologists also work closely with the medico-legal authority for the area concerned with the investigation of sudden and unexpected deaths i.e. the coroner (England and Wales), Procurator Fiscal (Scotland) or Coroner or medical examiner (United States).
Serves as an expert witness in courts of law testifying in civil or criminal law cases.

In an Autopsy, he /she is often assisted by an autopsy/mortuary technician (sometimes called a Diener in the USA).

Forensic physicans (sometimes referred to as 'Forensic Medical Examiners' or 'Police Surgeons' (in the UK until recently)) are medical doctors trained in the examination of, and provision of medical treatment to, living victims of assault (including sexual assault) and those individuals who find themselves in police custody. Many forensic physicians in the UK practice clinical forensic medicine on a part-time basis, whilst they also practice family medicine, or another medical specialty.

Investigation of death

Main article: coroner

Deaths where the cause is not known and those considered unnatural are investigated. In most jurisdictions this is done by coroner, medical examiner, or hybrid medical examiner- coroner offices.

Terminology is not consistent across jurisdictions

In some jurisdictions, the title of "Medical Examiner" is used by a non-physician, elected official involved in medicolegal death investigation. In others, the law requires the medical examiner to be a physician, pathologist, or forensic pathologist.

Similarly, the title "Coroner" is applied to both physicians and non-physicians. Historically, coroners were not all physicians (most often serving primarily as the town mortician). However, in some jurisdictions the title of "Coroner" is exclusively used by physicians.

Becoming a forensic pathologist

Forensic pathology is a subspecialty of anatomical pathology and forensic pathologists complete at least one year of additional training (a fellowship) after a general pathology residency. Becoming an anatomical pathologist requires completing a three to five year residency in anatomical pathology, which is something one does on completing medical school. In Canada^[4] and UK, anatomical pathology is a five year residency. In the US, anatomic pathology (as it is called) by itself is a three-year residency. Most pathologists complete a combined residency in both anatomic and clinical pathology, which requires a total of four years. The majority of pathologists also complete at least one additional year of fellowship training in a subspecialty area.

In the United States, all told, the education after high school is typically 13 years in duration (4 years undergraduate training + 4 years medical school + 4 years residency (in anatomic and clinical pathology) + 1 year forensic pathology fellowship). Generally, the biggest hurdle is gaining admission to medical school, although the failure rate for anatomic and forensic pathology board examinations (in the U.S.) is approximately 30-40 and 40-50 percent, respectively.

Becoming a pathologist

So, you want to be a forensic scientist? - Simon Fraser University.
When I grow up: becoming a pathologist by G. William Moore, MD, PhD. - netautopsy.org.
What is a Pathologist? - a perspective from UK pathologist Fraser Charlton.

Retrieved from "http://en.wikipedia.org/wiki/Forensic_pathology"

Forensic Pathology Careers: Frequently Asked Questions

Ed Uthman, MD

Diplomate, American Board of Pathology

13 Nov 1999

I am a general pathologist, not a forensic pathologist, but I am compelled to write on this subject by the large number of e-mail inquiries I get from young people who are thinking about careers in forensic pathology. Although I have sought and received advice from bona fide forensic pathologists in preparing this FAQ, all opinions (and errors) here are mine.

Q. What is forensic pathology?

A. Forensic pathology is the subspecialty of pathology that focuses on the medicolegal investigation of sudden or unexpected death.

Q. OK, so what is pathology?

A. Pathology is the medical specialty concerned with the diagnosis of diseases and injuries by examination of body tissues and fluids, typically in the laboratory setting. There are two main branches of pathology:

Anatomic pathology involves the morphologic evaluation of tissues removed from living or dead individuals, using the unassisted senses (sight, touch, smell) and the microscope. The three main areas of anatomic pathology are autopsy pathology, surgical pathology, and cytopathology. Forensic pathology is concerned almost exclusively with autopsy pathology, or evaluation of the deceased. General pathologists, on the other hand, spend most of their time practicing surgical pathology and cytopathology, in which specimens removed from living patients are examined.
Clinical pathology involves the evaluation of body fluids by laboratory means. The main subcategories of clinical pathology are chemistry, hematology, microbiology, blood banking, toxicology, and immunology. Forensic pathologists are most interested in chemistry and toxicology. Chemistry is concerned with measurement of natural chemicals in the blood, urine, and other body fluids. Toxicology is concerned with the detection and measurement of unnatural chemicals (poisons and drugs).

In the United States, most pathologists in private practice are certified in both anatomic and clinical pathology. This is not true in most of the rest of the world, where a given pathologist will be an anatomic pathologist or a clinical pathologist, but not both. If you are interested in a career in general pathology, there is a very nice summary of "Pathology as a Career", courtesy of Lousiana State University Medical Center - New Orleans Department of Pathology.

Q. How many years of schooling and training does it take to become a forensic pathologist?

A. After high school you'll have to undertake:

4 years of college, to get a bachelors degree
4 years of medical school, to get the doctor of medicine (MD) degree
4 or 5 years of residency (4 for anatomic pathology only, or 5 for combined anatomic/clinical pathology, the latter track being recommended) to become eligible to take the Board exams in pathology
1 or 2 years of forensic pathology fellowship, to be eligible to take the subspecialty Board exam in forensic pathology

Q. Wow! Thirteen to fifteen years after high school before you can get a job? To hell with that!

A. It's not as bad as it sounds. Of course you have to pay tuition and living expenses for the eight years of college and med school, but residents and fellows earn a decent living wage (about $26,000/yr to start). From what I've seen, the people who get in trouble financially are those that insist on starting families while still in school and borrow a lot of money to finance a middle-class, American-dream lifestyle. When they finally finish training, they are beset with the payback of onerous loans. On the other hand, if you're single, live in not-the-best neighborhoods, and split expenses with housemates, med school is very affordable, even fun.

Q. What do forensic pathologists do at work?

A. Forensic pathologists split their time among 1) performing autopsies, 2) acquiring data from investigating officers, and 3) testifying in court. Occasionally they may visit scenes of crimes or accidents, but I think this is uncommon for most.

Q. What personality characteristics are required in a good forensic pathologist?

A. Varying combinations of the following ingredients:

A talent for and interest in science. This should include not only biology, but physics, chemistry, and the social sciences (anthropology and psychology). For the bread-and-butter technical part of your work, you should especially have a good grasp of spatial relationships.
Good communication skills. You will not only be interacting with law officers, but you'll be trying to convince judges and juries that your findings are valid.
Strong stomach. You'll be routinely dealing with dismembered and/or rotting bodies. From a pure visceral standpoint there is no job more disgusting than forensic pathology.
Thick skin. You will be periodically raked over the coals by the local media, who apparently cannot to resist the urge to armchair-quarterback your work. You will also make many enemies among the citizenry. For instance, when you determine that Daddy killed himself, and he wasn't poisoned by that blond bimbo who was only interested in his money, you are going to have some very angry children buzzing around you.
The mind of a detective. You will have to constantly be on guard against being fooled by malefactors smarter and more focused than you. You will have to have some insight into the heart and mind of a criminal.

Q. What should I be studying in high school/college/med school to prepare for a career as a forensic pathologist?

A. In high school, concentrate on traditional core subjects and develop your study skills and self-discipline. Take four years of English, four of science, four of math. Take as many honors-level courses as you can handle, so you can test out of survey-level courses in college. By the time you graduate, you should be able to write clear, polished reports without grammatical errors. If you are shy or uncomfortable speaking in public, you may benefit from getting involved in your high school's debating team or other organized speech activities.

In college, you will have to meet prerequisites to get into med school. These vary from school to school, so get to know your college's premedical adviser early on. In general, you will need two years of chemistry (inorganic and organic), two of biology, one or two of English, and maybe one of physics. You don't have to major in a science to get into med school, and in fact some med schools encourage applicants to have strong backgrounds in the humanities. I can't argue with that, but I do think the current crop of young physicians is somewhat deficient in their grasp of the scientific underpinnings of medical practice. So, I guess what I would say is that if you don't major in a natural science, you should still take more science courses in college than are required by the med schools you are looking to attend.

I think that colleges generally do a better job of teaching biochemistry and psychology than do med schools, so you may wish to consider taking those as electives in college. Medical schools shine in the teaching of anatomy and physiology, so I would stay away from vertebrate anatomy and physiology classes in college. Since medical examiners often deal across cultural lines, you may also wish to enrich your knowledge of various ethnic groups by taking some courses in minority studies. Developing proficiency in a foreign language may come in handy, too.

In med school, concentrate your elective time in basic patient care. Remember that you will be a physician first and foremost. You should do an autopsy pathology rotation early on in your elective bloc, so you will get a leg up on the first day of residency, plus you will learn right away if a career in pathology is right for you. You may even wish to arrange an elective rotation at a large county medical examiner's office. These can usually be arranged, even if you have to travel hundreds of miles to get there.

Q. Where should I go to high school/college? Where should I do my pathology residency/forensic pathology fellowship?

A. You can go to high school anywhere. At any school, rich or poor, public or private, most of the teachers are mediocre, a few are totally incompetent, and a few are wonderful. The bottom line is that you, the student, are ultimately responsible for your education. Even if you are so unfortunate as to be the victim of uniformly abysmal teaching, the information is out there, and it is up to you to get it. Also, if you develop good time management skills in high school, college will not only be easier, but fun, too. The potential for an enjoyable social life in college is great, but you have to come armed with a sense of priorities to succeed both socially and academically on campus.

The choice of college is a little more important. I am going to tell you right off that I have a strong bias against two-year colleges (from which you could theoretically transfer to complete your premedical education at a four-year college). These are cold, dismal places populated by desperate students whose joie de vivre was left behind years ago. At eighteen, you don't need this.

I have a smaller bias against large, state-sponsored, four-year universities. For one thing, you are lost in the crowd. More importantly, your huge survey-level classes are often taught by unmotivated graduate students who may or may not be able to speak understandable English. Do you really want this? (Of course, many grads of large universities are quick to defend their almae matres, such as one individual whose e-mailed argument was so eloquent that I just had to post it here.)

This leaves four-year liberal arts colleges, which I highly recommend. Believe me, twenty years later, you'll be happy you made this choice. I think the college education is the single most important (but least appreciated) part of one's education. Its value is subtle, though, and it may take decades for its promise to flower.

Medical school is an easy choice: go to the cheapest one you can get into. The quality of education is the same in every U.S. school. You have the same textbooks, the same human bodies with the same diseases, and the same quality of faculty. Unfortunately, faculty members in med schools are not hired or promoted based on their teaching skills, but on their practice skills and research accomplishments. Don't get me wrong; there are plenty of excellent medical educators, but you never know where they'll turn up.

The choice of residency is more important. I strongly suggest a program associated with a university, not a private hospital (although you can rotate at private hospitals under the aegis of university-based teaching programs). So much of the value of a residency program depends on the rapport between residents and faculty. This is a hard parameter to measure from a distance, so you should consider doing a med school pathology elective in one or more of the departments you are looking at for residency training. It is usually easy to arrange this, even between schools in different states.

Regarding your forensic pathology fellowship, you will have to go to a big city to get sufficient experience. You will want to look for a program in which the fellow (you) does about 250 autopsies a year. Too many less than that, and you won't get enough experience. Too many more, and you'll be so busy you won't have time to read, study, and do thorough workups on your cases. Of course, you will also want to look for a place that has senior faculty you can respect and have rapport with.

Q. How much money will I make as a forensic pathologist?

A. The range I hear is $60,000 to $180,000, depending on experience, geographical area, and level of responsibility. As a government employee, your fringe benefits (insurance, retirement) should be pretty good. If you are good on the witness stand, you could become one of the corps of elite expert witnesses that fly around the country and command a handsome hourly consultant's fee.

Q. How about physical disabilities?

A. I think blindness would rule you out. I don't think there is any reason a deaf person could not do forensic pathology with appropriate assistance. As to whether a wheelchair-bound person could do it, I simply don't know. The microscopy and testimony part would be no problem, but physically doing an autopsy would require a lot of skilled assistance, especially during the training years. Minor disabilities, like colorblindness, absence of one limb, one eye, etc, should present no problem.

Q. Would I manage other people?

A. Yes. Even at the junior level, you would be expected to show proper management skills in handling dieners, histological technicians, and pathologist's assistants. As a senior person in a large medical examiner's office, you would manage other forensic pathologists.

Q. What are the advantages of being a forensic pathologist?

A. The hours are better than for most other physicians, but this is not a nine-to-five office job by any means. Don't even think about going to med school if you are a clock-watcher.

You have the satisfaction of not only helping to put criminals away, but of comforting grieving families, thus, "It was over very quickly. She did not suffer."

The job is very challenging, and boredom will not be a problem.

Q. What are the disadvantages of being a forensic pathologist?

A. Some are mentioned above. The pay is not all that great in comparison with that of physicians with similar years of training. Eventually you may become heavily burdened by the continual exposure to the all-too-graphic evidence of man's inhumanity to man.

Q. How does forensic pathology fit in with pathology as a medical science?

A. This is getting into some controversy, so let me reiterate that this is my opinion only.

All areas of pathology outside of forensic pathology are subject to peer review, by which the pathologist's work is formally reviewed and criticized by other pathologists. This is not uniformly true of forensic pathology. To a general pathologist, who is held to a near-100% accuracy rate in his or her diagnoses, the report of the findings of a forensic pathologist can read more like speculation than determination. The thinking that goes into the assessment of the cause and manner of death, as well as time of death, can appear very subjective in comparison to the thinking involved in clinical decisions on living patients. Furthermore, in the U.S. legal system, the only check on the accuracy of the forensic pathologist is the counsel for the criminal defendant. While all such defendants have the Constitutional right to counsel, this right does not include the right to the services of a forensic pathologist. Few criminal defendants can afford to hire such an individual, so claims made by the medical examiner are rarely challenged by a professional with equivalent expertise. Consider what a hatchet job O.J. Simpson's forensics experts did on the findings of the Los Angeles County Medical Examiner. In any similar trial of a non-wealthy defendant, those findings would probably not have been even challenged.

I recently voiced a similar opinion in a pathologists' professional forum. A forensic pathologist returned a thoughtful rebuttal, which I repost with his kind permission.

Q. Where on the Internet can I find out more about forensic pathology?

A. For an area that enjoys such popular interest, there is surprisingly little online. However, there are a few gems:

Hank's Forensic Page, maintained by Dr. Hank C. Chien at National Cheng Kung University Medical College in Tainan, Taiwan, is another excellent compilation.
The National Association of Medical Examiners has an online FAQ similar to this one but more straight info without editorial opinion. This is "So You Want To Be A Medical Detective?"