What it’s like to specialize in forensic pathology: Shadowing Dr. Melinek

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As a medical student, do you ever wonder what it’s like to specialize in preventive medicine? Meet Judy Melinek, MD (@drjudymelinek), a forensic pathologist and a featured physician in the AMA Wire® “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out her insights to help determine whether a career in forensic pathology might be a good fit for you.

“Shadowing” Dr. Melinek

Specialty: Forensic pathology.

Practice setting: Coroner’s office and private consulting practice.

Employment type: Government contractor and CEO of my own corporation.

Years in practice: 16.

A typical day and week in my practice:  On most days, I wake up around 6 a.m. and get into work at the coroner's office around 8:30. I meet with my colleagues and we review the reports we have from the deputy coroner's investigators. Each report describes the death scene of an individual whose body was brought into the office sometime during the previous 24 hours. Theinformation about the death is crucial for us in deciding whether we need to perform an autopsy or whether we can certify the cause and manner of death based on a medical record review alone. We perform autopsies in the morgue from around 9 a.m. to noon and then do paperwork in the afternoon. About once or twice a month, in most offices, a forensic pathologist may get called to go out to a death scene to work with police investigators in understanding what happened to the decedent, and in determining whether the case may be a homicide.

My typical work week is split up between three days performing autopsies at our morgue in the coroner's office and private practice consulting work the rest of the time. Some weeks I work a full schedule of 40 hours and other weeks I work less, about 20 hours, depending on the workload and deadlines. I seldom work more than 40 hours a week.

The most challenging and rewarding aspects of forensic pathology: From an intellectual standpoint, the most challenging parts of my job are figuring out why someone died when there is very little information (when the autopsy doesn't yield an immediate answer) or when there is too much information and none of it makes sense. From an emotional standpoint, helping grieving relatives understand what happened to their loved one can sometimes be extremely difficult.

The most rewarding aspect of my job is when I can figure out what caused the death of an individual that others have been stumped about, and when doing so brings closure to a grieving family. I also take tremendous pride in being given the responsibility of testifying truthfully and effectively in court. Explaining the circumstances of a death to a jury so that those twelve people can effectively perform their civic duty is a rewarding requirement of my professional duties.

Three adjectives to describe the typical forensic pathologist: Interesting, civic-minded and curious.

My colleagues are a very interesting group of people. Many of them have full family lives, outside interests that have nothing to do with medicine—horseback riding, music, writing, to name a few. One thing I love about forensic pathology is that, compared with other medical specialties, we doctors can "have a life" and still be able to meet the expectations of our job.

Being civic-minded speaks to the fact that work in this field is predominantly performed under government employ, at medical examiner or coroner offices. You can make more money in hospital pathology, but one thing that binds us forensic pathologists together is a duty-bound commitment to the pursuit of public health in the context of civic institutions.

Curiosity lies at the core of any career as a pathologist. The job is constantly changing and evolving and you have to stay on top of multiple fields of medicine to stay up to date. You cannot be a medical detective without having that drive to follow questions wherever they lead.

How my lifestyle matches, or differs from, what I had envisioned: In medical school, I wanted to be a surgeon. I loved fixing things and helping patients, but once I started my internship in general surgery I realized what a lousy fit that specialty was for me. I wrote all about my switch from general surgery to pathology in my memoir, Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner, which I co-authored with my husband, writer T.J. Mitchell. He remembers supporting me during that difficult time when we rarely saw each other, and asserts that the two of us would not be married today if I had not left surgery.

In contrast, forensic pathology has reasonable hours and allows for flexibility and family time. We are able to work together to raise our three children, and I no longer have to rely on him to do everything at home. We can take vacations; I can go to the school play. Most importantly, I am midway through my career and while my colleagues who continued in surgery are starting to get bored, I am anything but. I have plenty of time to teach—medical school, college and even high school—and I strive to imbue my students with the passion for medicine I have never lost.

Every day is a challenge, because you never know what you are going to get. We get to see the most extreme, most fascinating cases—ones that no other doctor sees or has managed to figure out. We are respected by the law-enforcement officials and attorneys we work with and there are plenty of job opportunities nationwide. I am strongly convinced I made the right career choice in pursuing forensic pathology.

Skills every physician in training should have for forensic pathology but won’t be tested for on the board exam: The most important skill is what can irreverently, but accurately, be called a “B.S. meter.” It's that sixth sense, based on training and experience, that tells you that something just isn't right with a story you are being given. You know you have to dig deeper, ask more questions, run a few more tests. I guess this skill would be helpful in any aspect of medicine, but it is especially crucial in forensic pathology because it is not infrequent that family members or friends of decedents try to cover up for their illegal activities, or that police officers give you a version of events that is incompatible with what you are seeing on the dead body. The body doesn't lie—and you have to have the confidence and skill to learn from it and to trust your own inner voice when that voice warns you that something isn't right.

One question physicians in training should ask themselves before pursuing forensic pathology: Are you absolutely fascinated by medicine; how the body works and what makes it fail? If the answer is yes, then this is the field for you! Ultimately, all the other negative aspects of the job—the stinky smells, the gruesome crime scenes, even the lower pay of working at a government job—those are relatively tolerable if you find yourself absolutely fascinated by the science of death, and constantly find yourself coming back to it. So if you are watching CSI and Forensic Files at night, and you always want to know why something happened to your patient, you ought to run right out and arrange a rotation at your local coroner or medical examiner's office.

Books every medical student in forensic pathology should be reading: Forensics: What Bugs, Burns, Prints, DNA, and More Tell Us About Crime, by Val McDermid, summarizes some of the key concepts in the field through interviews and anecdotes with multiple specialists. Spitz & Fisher's Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation is the most readable textbook in the field of forensic medicine, and a foundational reference for anyone working in my subspecialty.

The online resource students interested in forensic pathology should follow: I keep a full list of links to interesting websites pertaining to forensics. For studying, consult the Johns Hopkins Surgical Pathology Unknown Conference and Pathology Outlines. This is a notable collection of videos on blood stain pattern analysis. William A. Cox, MD, writes an excellent forensic medicine blog.

Quick insights I would give students who are considering forensic pathology: The best advice I have written for students is at this blog post, which offers step-by-step instructions about what to do at each level of education: high school, college, medical school and residency. There is even advice for foreign medical graduates.

For medical students in particular, I advise you to ask your pathology teachers about elective rotations that might be available in the third or fourth year of medical school. You also should talk to pathology residents in your institution and ask them who the best professors are to work with, then find a part-time lab job. If you can even spare a few free hours a week after school to help with experiments or do library research for another doctor, you will build a good relationship and get exposure and mentorship that no classroom experience will match. You can also find out if there is an elective rotation at the medical examiner or coroner's office, or just call up the local office and see if they are willing to take you on to do some volunteer work. This will give you the exposure you need to see if this is the right field for you.

Mantra or song to describe life in forensic pathology: Song: “(Don't Fear) The Reaper,” by Blue Öyster Cult. My motto is adapted from the movie “Forrest Gump”: “Death is like a box of chocolates. You never know what you're going to get.” Our mantra and vanguard slogan is this: “The body never lies.”

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