This website can be accessed anytime, anywhere – even in the autopsy suite (which could be useful in the case of an unexpected finding!) It focuses on the practical, hands-on knowledge required to perform high quality autopsies. It does not focus on the background information for various pathologies, as this is readily available elsewhere.
This information is designed to be available and accessible at all times, so that it can be integrated into the everyday workflow of a routine medical autopsy service. See the “Quick START Guide” for how to get going with the website, or the “Problem Based Approach to Medical Autopsy” for a more comprehensive description of how to use this website and a teaching/learning tool.
QUICK START GUIDE:
Just like modern electronics, there is a short way to get started with new technology, and a long way. Here is the basic idea – the “plug and play” summary for how to use this website:
After compiling the clinical history for your upcoming autopsy case:
Consider the possible diagnoses you are most likely to see at autopsy. These might come from:
the patient’s past medical history
the patient’s more recent clinical course leading up to death
questions from the clinicians at the time of death
Make a list of these diagnoses and use the homepage/search function on the website to read about these various diagnoses prior to entering the autopsy suite
We have tried to keep things short and you might even need to just read the Quick Tips at Time of Autopsy sections first, leaving the Quick Tips at Histology and Reporting for after you finish in the autopsy suite
If your case is particularly interesting to you, consider reading the “recommended resources” listed at the bottom – these are triaged by the article authors and are considered particularly useful/high yield articles for learning core concepts
In contrast, “additional resources” were used to write the article, but focus on the minutia
Example, fictional patient history: A 72 yo male with a remote history of cardiac bypass surgery, coronary artery disease, hypertension, and hyperlipidemia who contracted COVID and was subsequently hospitalized with acute respiratory distress syndrome. He had superimposed bronchopneumonia but was doing well prior to experiencing sudden cardiac arrest. CPR was attempted but was unsuccessful. The treating team is concerned about a fatal pulmonary thromboembolism.
The above is a simplified amalgam of not uncommon scenarios encountered on a medical autopsy service. While nothing might stand out as high-yield to read up on before starting the case, here are the relevant articles (currently available and soon to be available) that would be useful for this case:
Reading these articles will give you tidbits like:
Grafts from the internal mammary artery, used commonly in bypass surgery, have a unique staining pattern of the elastic lamina on histology
CD61 IHC can be used to help distinguish premortem and antemortem thromboemboli
If you are convinced, in particular if you are an educator/attending looking to integrate this into your practice, keep reading below. TheAutopsyBook.com can be a powerful tool to help residents understand their cases and take away more from each autopsy (which is especially important now that they only get ~30 of them before graduation!)
THE PROBLEM BASED APPROACH TO MEDICAL AUTOPSIES:
Similar to the way in which clinicians use the problem-oriented medical record (i.e., Subjective, Objective, Assessment, Plan, or “SOAP” tool) to help them effectively manage their patients’ health issues, autopsy pathologists should also utilize a problem-oriented autopsy record (“POAR” tool) to plan, execute, and report their autopsies. This approach to autopsy practice can help maximize the diagnostic yield from each procedure. Furthermore, using the POAR tool allows users of this website to operationalize the information contained throughout it.
Dr. Lawrence Weed envisioned and promoted the problem-oriented medical record (Weed 1968) for efficiently delivering optimal care. Subjective information (e.g., patient concerns and observations) and objective data (e.g., clinical evaluations, radiology studies, laboratory tests, etc.) are combined to form an assessment and plan for a patient’s medical conditions (i.e., working or established diagnoses).
As autopsy constitutes the practice of medicine (CAP 2015) in which pathologists also evaluate (and often reveal) a decedent’s multiple pathologies, autopsy pathologists should also utilize a problem-oriented autopsy record (POAR) to plan, execute, and report their autopsies. The POAR should be created during review and summation of a decedent’s medical record, and it can subsequently be referenced throughout all stages of autopsy performance and reporting.
The intellectual organization involved in composing the POAR will foster a complete, competent, and consistent approach in performing and reporting autopsies.
Utilizing a POAR facilitates teaching autopsy practice to junior pathologists who can be overwhelmed in the early stages of their training by the multitude of clinical and postmortem pathologies encountered in some decedents.
The POAR is particularly beneficial with hospitalized decedents who tend to have complex medical histories, as it facilitates efficient and effective evaluation of their many clinical issues to be addressed at autopsy.
The intellectual exercise involved in creating a POAR can help junior pathologists develop organizational and critical thinking skills, as well.
An overview of the POAR, including its creation and subsequent utilization in autopsy practice (Williamson 2021):
The many benefits from incorporating POAR into autopsy practice (Williamson 2021):
Williamson, Alex K. MD. Doing More With Fewer: Optimizing Value With Limited Numbers of Autopsies. AJSP: Reviews & Reports, 26(2):p 79-92, 3/4 2021. | DOI: 10.1097/PCR.0000000000000433
Weed LL. Medical records that guide and teach. N Engl J Med 1968; 278(11):593–600.
