Final Diagnosis, Inc.

“What Happened?”: The Need for Private Autopsies

For 30 years I have been performing complex autopsies primarily via my role as a board certified anatomic, clinical and forensic pathologist. A gap exists in understanding exactly “what happened”, particularly in deaths that do not fall under the statutory role of the medical examiner/coroner. Death certificates require simply the most probable causes, specifically that “likely” condition or conditions that lead to death. Whether that had anything to do with the true cause based solely on history (or lack of) is debatable. In reality a death certificate is good at indicating that a person “died” at a certain time/place. The death certificate in the majority of U.S. deaths is not a useful tool for statistical analyses of actual cause of death, but unfortunately the data, through no better means, is used that way. Current data on deaths due to COVID-19 are a great example. In some states that do not autopsy scene death traffic crashes, potential drug deaths, or adults under a certain age, the cause and manner determinations and time to death considerations can be completely off base. In my experience, most autopsies identify something new, often something interesting, and many times a variety of potential serious natural conditions, and even unknown traumatic causes are sometimes found. Further, just because a condition did not cause the death (yet) does not mean it is not important to know about, particularly for children and siblings. The presence of cancers, infections, heritable conditions, heart disease, neurologic conditions can be important things to know. Hospitals decades ago began lowering the rate of autopsies. The reason why is not entirely clear but perceived cost is one, combined with disinterest and lack of substantial autopsy experience by most hospital pathologists. Objectively documented complete autopsy findings can save grief and costs by ending speculation. Speculation is our enemy as it wastes time/money and fuels distrust. Documenting the lack of a finding (through a photo for example) may be just as important as documenting when we see a lesion. At Final Diagnosis Inc. the goal is simply to say and show what we see. For more info see www.theautopsydoctor.com