Doctors have always opposed mandated practice standards. I’ve heard the arguments for more than 30 years.
When I was a resident, one of the first pathology standards to be drafted listed the measurements, dissections and observations that should be reported whenever a pathologist examined a portion of bowel removed for cancer. The practices detailed in the standard were exactly those I’d been taught by my mentors, who were up in arms over the idea that standards they already espoused might be required by some outside agency.
Doctors should be allowed to use their judgment, they fumed. Standards lead to cookbook medicine. And no expletive-deleted, pencil-pushing bureaucrat should be telling us what to do. A corollary argument likened the bureaucrat to the proverbial camel: If you let him get his nose in the tent, pretty soon he’ll be in there all the way.
A 2009 report by the National Academy of Sciences said many forensic science disciplines are practiced by poorly qualified people whose techniques are based on inadequate or nonexistent science and whose work environments foster bias.
The Senate Judiciary Committee has held hearings, the White House has chartered a subcommittee and the National Institute of Standards and Technology is intent on fixing the problems identified by the NAS.
Forensic pathology wasn’t dinged badly by the NAS report, but medical examiners are worried. It’s a fairly common perception that when the feds try to fix something, there’s no limit to the amount of money they can spend or the amount of havoc they can create. The government might even try to impose practice standards.
Some feel the National Association of Medical Examiners should beat them to the punch by adopting standards its membership could live with. But NAME standards won’t be universally accepted, either.
One recent NAME proposal says X-rays should always be done when advanced decomposition makes visual identification impossible. It would be fine to apply that standard to a suspected murder victim, but surely not to every decomposing body.
In an urban setting where few people know each other, X-rays and DNA studies may be necessary to ensure accurate identification. But if you have one body and one missing person in a small community where most people know each other and everybody else’s business, identification is straightforward.
There’s no reason to think a decomposed body sitting in a chair in the missing person’s house, wearing the missing person’s clothes and jewelry, with the missing person’s picture ID in a pocket and the TV tuned to the missing person’s favorite channel isn’t the missing person.
Who else would it be? As one colleague said, does anybody really think the CIA might have killed a spy, spirited away the missing person and planted the spy’s decomposed body in the missing person’s house?
I didn’t feel the need to order X-rays on every decomposed corpse during my tenure as coroner in Durango. A standard that requires expensive X-rays in all such cases is an unneeded, unpaid mandate and the brainchild of some bureaucrat who thinks forensic pathologists are incapable of exercising professional judgment.
When I was a resident, I was used to being told what to do. I couldn’t see that practice standards posed much of a problem.
Now, I’m a board-certified forensic pathologist with 30 years’ experience under my belt. I’m perfectly capable of exercising good judgment; I don’t need a cookbook. I don’t want some expletive-deleted, pencil-pushing bureaucrat telling me what to do.
Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12 She now lives in Florida and Maryland. Email her at firstname.lastname@example.org.