The most vulnerable need not die

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Go figure, I’ve been in a holiday mood lately and with things slowing down at work there is extra time to catch up on some seasonal episodes of my favorite shows.  Last night was NCIS season 11 episode 11: “Homesick”.  The story line is that a severe respiratory disease is affecting the children of military personnel around the DC area.  As the team works with the Centers for Disease Control and Prevention (CDC) to identify the source of the infection, Dr. Mallard, the NCIS Medical Examiner,  calls Gibbs to notify him of the first fatality.  When Gibbs asks which of the children has died, Mallard replies

When it comes to infectious diseases, the old are just as vulnerable as the young.

Camera then pans to an ashen-skinned, gray-haired male lying in an open body bag.  Who knows where thoughts come from; but, that single line from a fictional show set forward an internal tirade revolving around the real price American’s pay each year due to two (mostly) preventable illnesses, influenza and pneumonia.  The price is paid in terms of hospitalization costs, lost days of productivity, and, in the worst of cases, with loss of life.

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How is tissue processed?

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Whether removed surgically, traumatically, or via autopsy; tissue samples to be reviewed by pathology will be processed to facilitate creation of microscopic slides.  Slides are sheets of glass with mounted slices of tissue cut so thin that light shines through.  Through staining, the pathologist can use a microscope to identify characteristics of the cells based on their shape and color.  The formation of the cells and relationships with adjacent cells is how pathologists make such a precise diagnosis.  How the large pieces of tissue are processed to create diagnostic slides is an interesting process involving many steps and various laboratory professionals.

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Pathology: more than autopsies

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Sometimes when I meet new people and tell them what I do, their first question is something like “So you do autopsies on dead people?”  My thirty second elevator pitch must need some work because their eyes usually glare over and they politely excuse themselves when I explain that, unless you work for a medical school or Coroner’s/ME Office, autopsies are a small part of the job.  It’s a shame that most of the public’s only experience with pathology is the unrealistic dramatizations observed in movies or television.  There are a large number of health care workers that also don’t understand that pathologists do so much more.

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Why does it take so long to get a death certificate?

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Q: If the Medical Examiner can do an autopsy and release the body to a funeral home for burial within 72 hours, why does it take a month (or more) to get the pathology report and death certificate?

The simple answer is: because that is how long it takes.  Things are not always simple so here is a more complete answer.

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Sustainability of the ACA

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The intent of the Affordable Care Act (aka Obamacare), to insure under-served Americans, is certainly admirable.  It is crazy, however, to expect a family making $64,000/year to continually bear the full brunt of marketplace rate increases of 9-19% a year.

Middle class families ($64 – 125K/yr) are already paying 8-20% of income to pay for middle-of-the road (silver) coverage, not including deductibles and co-pays. As GAO shows that salaries are increasing slower than cost of living (2% vs. 4.25%) the middle class cannot continue to cover these costs.

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