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 physicians (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.

In the United Kingdom, Membership of the Royal College of Pathologists is not a prerequisite of appointment as a Coroners Medical Expert, i.e. doctors in the UK that are not forensic pathologists or pathologists do medicallegal autopsies.

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.

Canadian coroners

In Canada, there is a mix of coroner and medical examiner systems, depending on the province or territory. In Ontario, coroners are licensed physicians, usually but not exclusively family physicians. In Quebec, there is a mix of medical and non-medical coroners, whereas in British Columbia, there is predominantly a non-physican coroner system. Alberta and Nova Scotia are examples of ME systems

Coroners and medical examiner in the US

In the United States, a coroner is typically an elected public official in a particular geographic jurisdiction who investigates and certifies deaths. The vast majority of coroners lack a Doctor of Medicine degree and the amount of medical training that they have received is highly variable, depending on their profession (e.g. law enforcement, judges, funeral directors, firefighters, nurses).

In contrast, a medical examiner is typically a physician who holds the degree of Doctor of Medicine. Ideally, a medical examiner has completed both a pathology residency and a fellowship in forensic pathology.

He or she may also be board certified by the American Board of Pathology in Anatomic (and sometimes Clinical) and Forensic Pathology. This entails passing separate examinations in anatomic pathology and forensic pathology. To be eligible for the American Board of Pathology's board examinations, a candidate must demonstrate that he or she has completed training in anatomic pathology and forensic pathology at programs accredited by the Accreditation Council for Graduate Medical Education.

A forensic pathologist is NOT a coroner.

History

Forensic pathology was first recognized in the USA by the American Board of Pathology in 1959.

In Canada, it was formally recognized in 2003, and a formal training program (a fellowship) is currently being established under the auspices of the Royal College of Physicians and Surgeons of Canada.

Becoming a forensic pathologist

Forensic pathology is a subspecialty of anatomical pathology and forensic pathologists typically complete at least one year of additional training (a fellowship) after completing an anatomical 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 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 US pathologists complete a combined residency in both anatomic and clinical pathology, which requires a total of four years.

In the United States, all told, the education after high school is typically 12 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.

External links

• National Association of Medical Examiners (NAME)
• American Academy of Forensic Sciences
• Forensic Science Society
• British Association in Forensic Medicine
• British Association for Human Identification
• British Academy of Forensic Science
• Forensic Medicine for Medical Students - a website providing educational resources in forensic medicine
• Faculty of Forensic & Legal Medicine of the Royal College of Physicians
• Royal College of Pathologists of Australasia

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.
• Royal College of Pathologists of Australasia - There are career pamphlets on the main page down the bottom.

See also

• Forensic science
• Coroner
• Forensics

Further reading

• Spitz and Fisher’s Medicolegal Investigation of Death – Guidelines for the application of pathology to crime investigation’, 4th Edition, Spitz WU (Editor), 2006 Charles C Thomas Publisher Ltd, Springfield Illinois ISBN 0398075441
• ‘The Hospital Autopsy’, Burton J and Rutty G (Ed)(2nd Ed), 2001 ISBN 0 340 764201 Arnold Publishers
• 'Knight's Forensic Pathology',(3rd Ed) Saukko P. and B. Knight (2004) ISBN 0-340-76044-3
• 'Forensic Medicine: Clinical & Pathological Aspects'. 2003 Payne-James JJ, Busuttil A, Smock W (Ed) Greenwich Medical Media ISBN 1-84110-026-9
• 'Encyclopedia of Forensic & Legal Medicine'. 2006 Payne-James JJ, Byard R, Corey T, Henderson C. Elsevier (Academic Press). ISBN 0-12-547870-0