What makes a person become a pathologist?

On March 17 a round table was held with participation of leading pathologists and members of the Russian Public Chamber. Doctors were complaining to politicians about the decline of the postmortem service in Russia. As a result, living patients suffer, and the country is losing the clear picture of the state of health of its citizens.

Russian pathologists said that the number of autopsies conducted in the country was low.

The statement was made by Lev Kaktursky, the president of the Russian Society of Pathologists, director of the Institute of Human Morphology at the last meeting of the members of the Public Chamber.

According to Kaktursky, fewer than 60% of people who pass away in hospitals get an autopsy. As for the Russians who die at home, an autopsy is conducted only in 10-15% of cases. The share of people who died at home in 2008-2010 was 80%.

Kaktursky noted that the low number of postmortem studies conducted in Russia does not allow health authorities to obtain accurate information about the causes of their death. In addition, defects in clinical diagnosis and associated faults of clinical work remain out of sight of the leaders of medical institutions.

The director of the Institute of Human Morphology said that the reason for it was the fact that pathologists reported to hospital administrators not interested in the discrepancies between diagnoses. In this regard, he proposed to consider converting pathological service to an autonomous structure with the creation of pathological offices not reporting to medical institutions.

The academician believes that another reason is the desire of firms providing funeral services to quickly arrange the funeral. According to Kaktursky, the situation may be fixed with a new draft law "On basics of the health of Russian citizens", listing the conditions of mandatory autopsy. However, experts noted that the bill contains provisions that prevent the improvement of the situation. In particular, according to the document, body organs and tissues of the deceased can be used only with the written expression of the will made by these individuals during their lifetime and certified by a notary.

In the eyes of ordinary people the profession of a pathologist is unattractive and creepy. Often these professionals are tasked with the duties of forensic experts who get all "criminal bodies". In reality, pathologists conduct autopsy on those who died from natural causes, and the actual autopsy is only a smaller part of their work.

"Most of the time we work with the biopsy material," said Valentine Sergeichenko, a pathologist of one of the Moscow City Clinical Hospitals. "We are diagnosticians and radiologists. We are also clinicians, physicians and surgeons. Most people think that we work with corpses. Yet, in reality, when a pathologist examines biopsy material obtained, for example, from a patient suffering from benign (or malignant) breast tumor, the life of the patient depends on our conclusion.

Autopsies that are believed to be our main job, unfortunately, may soon become the past. Why "unfortunately"? Until 1990 we were conducting autopsies in nearly 70% of all deaths. This allowed us to know the cause of death and mortality rates from various types of pathologies. Most importantly, we were able to establish the reasons for misdiagnosis, and our conclusions were a learning material of practitioners.

In 1991, the Duma passed a law that autopsy can be done only with the relatives' consent. This may cause impunity for physicians. The patients will die, they will be buried, and no one will be asking questions. Moscow and other regions adopted sub-laws stating that if a patient had at least some medical procedures after the admission to a hospital, the autopsy was mandatory.

Yet, Russian people found some loopholes. The relatives of the deceased would give doctors money in an envelope. The doctors would indicate the causes of death communicated to them by the relatives. Five to six years later we will encounter a situation where doctors will absolutely not be afraid of making mistakes.

In 2010, more than half of Russian forensic experts were over 60 years old, 40 - 45% were close to the retirement age, and there were no more than 2 - 3% of young people under 30.

The profession is not popular among youth due to low salary. In any other developed country, a pathologist is paid only a little less than a surgeon, because in the West people realize that without the pathological anatomy it is impossible to properly diagnose.

A Russian pathologist B. Sergeichenko answered the readers' questions.

"Do pathologists have professional superstitions?"

"I do not have any. Yet, one thing is certain: no pathologist will conduct an autopsy on the person they knew personally. There is one unwritten law: if you are conducting an autopsy on a patient with tuberculosis, you must eat beforehand, otherwise the risk of infection is very high."

"Is it true that unscrupulous doctors wait for the end of autopsy behind the door?"

"By law, doctors must always be present at the autopsy, there is no need to hide behind the door. However, doctors are not always able to break away from the treatment process, in which case they familiarize themselves with the postmortem diagnosis later. The information about medical errors is delivered to the chief doctor and hospital department heads, and they have to decide what to do with it."

"How do you keep sanity doing this work?"

"When I became a pathologist, I was wondering about that myself. I concluded that there is a psychological defense within us. When you read medical history, you see a live person in front of you, but before the autopsy some internal switch actuates. I am curious to understand the type of pathology and why it happened.

Kirill Matveev
Medpulse

Read the original in Russian