CHOOSING A PATHOLOGIST AS AN EXPERT WITNESS
Pathology, the study of disease, is the broadest of the medical specialties. Pathologists neither
treat patients nor do surgery themselves. They act in the capacity of consultant to primary care and specialist physicians.
There is no medical specialty that is not within the purview of the pathologist and there is no physician who does not
in some way depend upon the pathologist for the care of his patient.
The specialty has two main subdivisions - anatomic pathology and clinical pathology.
Some pathologists specialize in only one but most practice in both areas. As in all medical specialties neither
board certification nor even board eligibility is required to practice. The majority of pathologists are certified
by the American Board of Pathology in either anatomic pathology, clinical pathology or both areas.
Anatomic pathology entails diagnosis of disease and injury by the gross and microscopic
examination of tissue specimens, biopsies, organs, pap smears, bone marrow aspirates and blood smears. The anatomic
pathologist is also the one who performs autopsies. A part of anatomic pathology is surgical pathology which is
concerned with the examination and diagnosis of tissue specimens removed during surgery. It is the surgical
pathologist who responds to the operating room for frozen sections for rapid microscopic diagnosis to guide the
continuation and completion of surgery.
In training for anatomic pathology resident physicians spend the greatest segment of time
learning gross and microscopic diagnosis. This involves first learning the unique gross and microscopic appearance
of every organ and body tissue. Once able to recognize normal tissue the pathology resident must learn to recognize
the many alterations in appearance caused by injury and disease.
Clinical pathology deals with the medical laboratory where the pathologist serves as medical
director. The pathologist bears ultimate responsibility for medical laboratory test results. The modern clinical
pathology laboratory offers a large repetoire of tests on a large variety of specimens. Clinical pathology residents
are required to expand their knowledge of the basic sciences well beyond that learned in medical school. They must
learn the fundamentals of instrumentation and statistics and master principles of quality control. Somewhere along
the line the clinical pathologist must also develop skills in management, administration, medical politics and economics.
Board certification in both anatomic and clinical pathology requires four years of full-time
postgraduate training beyond the M.D. degree. Some pathologists elect to specialize in anatomic pathology or clinical
pathology only, and for each the residency is three years. Pathologists trained in anatomic and clinical pathology who
take the board examination in both fields but pass only one will not be certified in either, reflecting a both-or-none
policy. Even for an issue confined to anatomic pathology alone it is generally held that the pathologist with dual
certification may be preferred because of their broader understanding of medicine.
Some board certified pathologists opt for a fifth year of formal training which can lead to
added certification in a recognized subspecialty such as neuropathology, pediatric pathology, immunopathology,
microbiologic pathology, cytopathology, hematopathology or forensic pathology.
This subspecialty deals largely with death cases. Some forensic pathologists are anatomic
pathologists only, whereas others hold dual anatomic and clinical pathology certificates. By tradition forensic
pathologists distinguish themselves from non-subspecialty pathologists by referring to the latter as hospital
pathologists, especially in the context of autopsies. Forensic pathologists perform hosptial autopsies but hospital
pathologists do not perform forensic autopsies.
Forensic pathologists receive special training in the recognition and interpretation of wounds.
They become familiar with, but are not themselves expert in, ancillary fields of death investigation such as criminalistics
and forensic toxicology. When doing a medicolegal autopsy the forensic pathologist is aware that, no matter how mundane a
case may seem, there may be future questions requiring answers that were obtainable only at the time of autopsy.
Thus they have a tendency to be thorough on every case, documenting what is there and what is not.
One goal of the forensic pathologist is to determine the cause and circumstances of death.
The breadth of the word "circumstances" quite well reflects the multitude of areas with which the forensic pathologist
must concern himself.
For purpose of assisting attorneys the ideal forensic pathologist is also a hospital pathologist.
A forensic pathologist who practices anatomic and clinical pathology in the hospital setting has a broad and up-to-date
understanding of medical issues. This may not be the case for someone who works full-time at a medical examiner/coroner's
The forensic pathologist wishes not only to serve as the protector of the rights of the deceased
and of society but also to assist in the prevention of disease and injury. In this sense the dead can truly help the
living. First and foremost the forensic pathologist seeks the truth.
The pathologist should be trained and experienced in the area of pathology at issue and
currently in active practice. It makes no sense for example to expect a university professor who sits as administrator
and chairman of a large and busy department to address the issue of missed cancer on a prostate needle biopsy.
No individual could master the entire specialty yet the vast majority of cases can be handled
by one pathologist. A few cases require the expertise of a subspecialist or a superspecialist/professor.
The best superspecialist expert witness is one who is actively practicing within a hospital. Most pathologists
have at least a few publications and superspecialists usually have many. Superspecialist/professors should have a
bibliography that verifies their area(s) of expertise.
The Ideal Pathologist Expert Witness:
The ideal pathologist as expert witness is board certified in anatomic and clinical pathology.
The expert should be actively practicing in a hospital, serves on hospital committees, is a member of the county medical
society, serves on committees at the county medical society level, is active in teaching physicians, nurses and
laboratory staff, is a fellow of the College of American Pathologists and the American Society of Clinical Pathologists,
is a member of the state pathology society, directs a clinical pathology laboratory that is certified by the College of
American Pathologists, has no recent or frequent job changes and is known and respected in the community. Credible
witnesses should be able to accurately and clearly summarize complex medical issues.
Case Types Requiring a Pathologist:
Common anatomic pathology issues include missed cancer diagnosis, false cancer diagnosis,
pap smear misinterpretation and errors of frozen section interpretation. Examples of purely clinical pathology cases
are specimen handling/processing errors, incorrect laboratory results, inappropriate response to laboratory result,
untimely reporting of critical laboratory results and transfusion reactions. Case examples that require combined
anatomic and clinical pathology skills are surgery accidents and deaths, anesthesia accidents and deaths and blood
transfusion catastrophes. Purely forensic pathology issues involve unnatural death, i.e. accident, homicide, suicide
or unknown, toxicology problems, accident reconstruction, crime reconstruction, time of death, funeral director error,
exhumation, paternity dispute, food poisoning and an extremely varied array of other situations and events that end up
Armed with knowledge of the medical specialty of pathology the legal professional can find the
right pathologist for the case at hand.