How to become a Medical Examiner (Forensic Pathologist)

for decades television crime dramas have fascinated viewers and inspired others to choose a career in law enforcement a staple of many of those programs is the job of medical examiner some shows have a main character who is a medical examiner layer it’s quincy emmy in the 1970s or more recently shows such as bones castle and NCIS many students say they’re interested in the work of the crime scene investigator and more specifically the medical examiner boa is the job of a medical examiner also known as forensic pathologists and is that job painting like what’s depicted in a one-hour entertainment program to get answers we went to the best the New York City office of chief medical examiner established in 1918 OCME employs about dirty forensic pathologists who perform autopsies 365 days a year when doctors want to train as medical examiner’s this is where they want to come about 25% of the board-certified Emmys in the United States have been trained by this office meet dr. Kristen Roman during a visit in December we asked the veteran pathologists to describe a typical day for her the nation’s busiest office Roman told us she alternates between paper days and case days when she performs autopsies during an autopsy day and we come in and were presented with the list of people who have died and have been brought to the morgue and as a group we sit and go over that and decide whether people will have an autopsy or not then those cases are assigned and we all go and do autopsies in the morning we have students with us and we have trainees that were training as we’re doing the autopsies at the end of that we then do a little bit of paperwork we have a end of the day meeting where we go over the cases of the day with the boss who’s usually not there in the morning and then that’s the end of the day so mostly our day is about doing the cases dr. Roman says the time she spends in court varies lately not so much but there have been times when I’ve gone a couple of times a month there are two main reasons well actually let me change that three we go for what the grand jury which is when they are trying to decide whether or not they have enough evidence to have a trial so we go to those pretty frequently pretty much every case is suspicious gets one of those if a trial is decided upon if it’s like a homicide trial we go and we testify in a full homicide trial and then there are civil cases those are a little different this is when we’ve done an autopsy on somebody and the family suing a hospital or suing the bus company or suing somebody in those cases we sometimes testify in as well so those are the main reasons why I would go to court as for dealing with Harden those defense attorneys I enjoy it it’s a challenge according to dr. Roman there are certain criteria used when the citing which autopsies to perform any case that’s a homicide where we think somebody’s caused another person’s death automatically gets an autopsy any case in general where the death isn’t 100 percent natural if there’s been some sort of intervention in the form of a motor vehicle collision or some other sort of accident those will get an autopsy suicides will get an autopsy natural cases may or may not depending on how clear the history is also one thing that’s unique to New York is that it we honor religious objections in a lot of cases so unless it’s a homicide if the family is Jewish or Muslim and they object we will often honor the objection that’s unusual to us autopsies can also help to determine unknown medical conditions even when a patient is not initially brought to the city medical examiner that’s usually the hospital setting having said that it does happen where people will have not gone to a doctor they’ll be found dead in their home so nobody really knows why they’re dead we will do the autopsy to figure out why they died and we’ll find a medical cause and then we can tell the family oh he had brain cancer like you’re suggesting or oh he had heart disease no one knew about so sometimes we do it’s not our basic purpose that sometimes it happens actually dr. Roman says her work also helps to advance medical knowledge in other ways we do that kind of every day because what we do is so much clearer than what can be done on the living there are limits to what you can do on the living because you don’t want to cause their death or injure them right whereas we can do any invasive thing that needs to be done to get to the answer so every day we’re providing another little fact and this is extremely rewarding it’s rewarding for me personally because I’m a curious person and I like to know what happened and that’s part of why I like this job and it’s rewarding because you do feel like you’re adding to medical knowledge dr. Roman says the favorite part of her job is I have to admit it’s the actual

autopsy I love doing autopsies it’s a little of each I mean there are cases where I kind of know what I’m going to see inside and when I see it I’m like of course I’m seeing that and that’s nice and then there are the cases where you think you’re going to see something and that’s not what you see at all it’s never boring could be anything it’s similar to those types of things though I mean we will often find bullets we didn’t know we’re there and that always changes entirely how you approach the case that happens a lot a lot of people walking around with bullets it is also thrilling just as a doctor to see somebody who has no health history open them up and find out what happened even if it’s just medical that’s exciting because you don’t know what you’re gonna find we asked dr. Roman what actually happens during an autopsy we begin with an external examination when you’re talking actually in the autopsy I mean before the autopsy we look at an investigation and all that stuff but when the body’s on the table the first thing you do is you look externally and you can learn a tremendous amount from looking at people externally I have to say that sometimes when I’m sitting on the subway or the bus I will look at people and be like that one’s got heart disease that one drinks because you start to recognize those things you know and so the first things that I do or I look at the external body and look for the changes that are going to correlate with what I find inside dr. Roman explained there are many ways the public benefits from the expertise of her office that’s a really important part of this job some of the cases that are natural deaths that we will accept will be cases that are a public health concern like if there’s an epidemic for example like West Nile and set the lightest with something or a flu epidemic so our autopsies provide data about how this occurs how it unfolds who get sick etc and that feedback is used to treat people effectively it also comes up in deaths that are related to products or deaths that are related to problems with cars and other vehicles our autopsy findings help people to improve products so that they don’t hurt us when we’re using them that’s very important and the other place where our knowledge is really applied is in the criminal justice system if I haven’t done an autopsy to prove that the gunshot wound 100 percent cause somebody’s death the prosecutor cannot prosecute somebody for possibly doing that to someone so the autopsy is very important in that sense to perhaps surprising is the fact that most cases are no mystery I don’t know if I can say percentage I would say that by and large it’s fairly black and white that’s the beautiful thing about the body it doesn’t lie it tells you its story and if you pay attention it’s right there so that part of it is very very black and white the gray areas come in when you’re dealing with families how much do you tell them enough so that they know but not so much that they hear something they didn’t really want to hear stuff like that you know it’s more in the dealing with other living humans that it gets grayer while science would seem to be at the top of the list for an Emmy dr. Roman says that communication with families is also a priority and that I would say is the most important thing that I do actually in terms of how how we serve the public it’s a very difficult thing to do people when they’re grieving are not at their best they’re often angry they’re definitely sad and it can be a challenge to talk to them it’s a challenge to communicate things and have it be remembered you often have to have multiple conversations because grief affects how you’re thinking you often deal with a lot of aggression from them they don’t want you to cut up their love for the winos they’ll stay so you know people have a lot of emotion so you have to be a very strong person and to be able to sit and talk to look someone grieving and convey information ask questions and communicate to them what they need to know I think a lot of it has to do with being kind of a good person you know being able to like listen to others I think it’s more like social skills but it certainly improves with practice I remember the first grieving family I was almost stunned by the extent of their emotion I didn’t realize it would be that much and now I’m no longer stunned by that I know how to sit and let it happen and then when it subsides I can begin to talk to them so it is a skill that you improve over time like everything else we do in this field dr. Roman says that Trust is important therefore privacy is respected a lot of people think that we go to cocktail parties and talk about our cases we don’t I have a tremendous respect for the people and their families who I serve so I don’t talk about the stories I don’t talk about the crazy stories because they trust me not to do that it is ability to communicate that can produce satisfactory results for both sides especially with reluctant and resistant loved ones it is discussed

because that’s something that frequently happens that we must do an autopsy to determine and why somebody died and the family doesn’t want this to happen to the relative so I usually it’s usually a long discussion and I usually talk to them about you know how it can be done respectfully and you know as with this least invasion as possible you know but I still get what I need in terms of certifying the death I’ll often talk to them too about the importance of knowing why somebody died in case they have sons or daughters if it’s an inherited condition we need to know to protect the living you know when also if it’s like an infection or something like that we need to know to protect the living who might have caught it so generally you can get people to understand that you’re not crassly mistreating their relative you’re doing this with respect you’re doing it for reasons that are very important and usually you can convince people to let you do it because they grow to understand that it’s the best thing that it can be done yes that’s correct I’m trusted with their most prized possession no doubt the work of the forensic pathologist is important in many ways although not the case with dr Romans office there is nevertheless a critical shortage of properly trained Emmys in the United States according to a national commission on forensic science between 1100 and 1200 Emmys are needed there are only about 500 and her average age is 50 to quote the shortage involves not only the inability for communities to recruit FPS but an inability to retrain them in practice consequently forensic autopsies are being performed by non forensic pathologists who may not be qualified in some cases autopsies are not performed when they should be I think the main reason there’s a shortage is that death investigation is evolving traditionally the country has had their deaths certified by coroner’s who are non medically trained appointed people who just go in and certify a death and as knowledge is evolving a lot of jurisdictions are now requiring a trained person in forensics like myself a medical examiner to go ahead and certify the death you know not some guy who’s appointed who runs a lawn service and he has friends in town but somebody who knows what they’re doing also in a lot of the states there are mandates that once the population reaches a certain amount they must have a medical examiner so it’s mostly due to growth of the sort of knowledge and the country and population that’s the main reason why there’s a shortage in terms of what we can do to change that it’s a very attractive field I think that more and more people are starting to be attracted to it because it’s so publicized on television and the main thing is for those of us who are trained to train our successors right we train the new ones so I think that that’s the biggest thing that you know I can do is train more people to do what I do so they can take it out of New York and do it somewhere else obviously employment opportunities are there you will get a job in this profession I mean like you said there’s a shortage there our medical examiner offices opening up based on population and statutes like I mentioned and if you’re willing to leave places like the big cities Los Angeles New York etc if you’re willing to go a little more rural there are tons of job opportunities so it’s a great field to go into students should be aware of the differences between the reality of the job and Emmys portrayed on television there are a lot of differences I mean I think the most glaring one is we don’t look quite as good as they do that I think the main thing that I hear about from families is everything happens quickly on television everything happens slowly here because our patients aren’t living the labs are slower the tests come back slower so it’s a much more drawn-out process what I do as opposed to the one hour wrap up that happens on television the other thing is on television the medical examiner sort of is almost part of the investigating squad with the cops and the district attorneys I’m thinking of law and order for example one thing that’s very important about what I do here is that we are independent of them we don’t work with them we aren’t swayed by what we think what they think of what we do we’re independent so we don’t have that same sort of camaraderie that you see on television in fact sometimes where it ODS I think those are the two main differences that’s not true sometimes I do it depends on the case if it’s a homicide and usually I don’t show up to look at the body we have investigators that do that but I’ve certainly gone back to scenes to do a second look if I’ve seen something on autopsy that doesn’t make sense given the investigation I’ve seen I’ll ask to go back and have a second look without gonna find the case tell me give me an example I mean I think it happens most

frequently for all of us not just me and suicide cases because very rarely is it clear the intent so we’ll often go back to make sure it’s a suicide as opposed to a homicide another example of when most of us will tend to go back to a scene is a child abuse case because very subtle things can cause a child’s death and they’re things that often missed by people who aren’t trained as fully as we are so I would say child abuse and suicide are the main ones I would go back and visit I think there’s one think we need to mention too and this is maybe a little bit odd but for people who are planning to go into this field they don’t show this part on television but when you’re doing an autopsy it’s messy and it’s smelly so if you’re somebody who doesn’t like icky things this is a job that you probably don’t want to think about doing and I have had people get pretty far in their training before they realize that so that’s something to think about if you can’t look at a dead cat on the road you probably can’t look at a dead person on a table if the job is for you becoming an Emmy requires a four-year college degree a four-year medical degree and training to become a board-certified forensic pathologist dr. Roman however did not take a traditional route that was not a straightforward decision I started out when I was of high school age wanting to be an artist so I actually went to art school functioned as an artist here in New York and was sent back to medical school by the AIDS epidemic because I was here in the 80s my friends were dying so I went back to school and I did a lot of different things in medical school I had trouble choosing what I wanted and actually ended up choosing obstetrics and gynaecology didn’t like it so I went and spent a year with the pathology department just because they had an open position the first rotation was Medical Examiner and I was hooked because it’s just so very fascinating it puts everything in medicine together and I loved that about it so I came to it in sort of a convoluted way but I stuck with it because I loved it completely a happy accident yes I actually was an artist and I was a sculptor I had some work shown in New York actually I had did welded pieces that had motors asked for advice for students dr. Romans said that’s a really hard one for me to answer because if you would look at my career I did everything wrong and I’ll tell you I mean in high school I enrolled in the upper level college prep advanced placement courses and when I decided I wanted to be an artist which was my junior year I dropped them all so I didn’t complete the advanced Sciences I went to art school and didn’t study any science so I sort of narrowed my focus right away however when I changed my mind and wanted to go back to school I went back and did those courses and you know if you want to avoid that if you want to avoid having to go back and redo things then you should start planning ahead right away you know you need to have basic sciences and math because you need those to get into a pre-med program when you’re in pre-med you know you have to create good grades so you can get into a Medical School and then once you’re in medical school you have to perform well and take classes that will prepare you to go into a residency in pathology so if you’re gonna do the straight shoot it involves a tremendous amount of planning and I think one thing I would suggest to students who are going to undergo this it’s a lot and most of our families I know mine weren’t prepared for that sort of thing and that’s one of the reasons I took the course I took if you don’t have an adult in your life who can mentor you find one there’s always somebody who can help you with this kind of planning and preparing according to dr. Roman it takes a strong mindset and a determined approach to do the job death is very difficult to deal with if you speak to a doctor who doesn’t do what I do death is their enemy and they don’t want to talk about it they don’t even often want to sign death certificates for their patients so it takes a special person to do this and my experience has been watching students come in who are interested they pretty much know immediately they see their first autopsy and they know I can do this or I can’t do this so the initial decision is usually very very easy over time burnout becomes a different thing because dealing with death on a daily basis kind of changes how you see the world you know I don’t see the cute baby sleeping in a crib I see the cute baby sleeping facedown who’s at risk of suffocating so I see the world very differently so you have to kind of work with your own mind to not always think that way so that you can you know leave this job here and step out man you know enjoy life so you know you have to do things like cultivate an active life outside I run I have a family I

keep dogs you have to find things that keep you thinking differently from the way this job has you thinking dr. Roman explained that it’s helpful to her job requires working and interacting with colleagues I would say that of physicians medical examiner’s are one of the more pleasant groups to hang out with we do tend to work together and discuss cases and whatnot also unique to our job is we don’t work sort of in a vacuum sort of the way that doctors have nurses we have mortuary technicians we have scene investigators we do have the police come to view autopsies sometimes so we interface with a tremendous amount of people every day so there’s a lot of interaction so you’re always meeting new people working with new people my colleagues are great people to work with I would say if you like if you’re social it’s a great job if you don’t want to do with people who don’t do this job because it’s all about people during an after Medical School dr. Roman also has curriculum and advice for students and doctors and it’s not to learn more Anatomy it’s to learn to manage stuff anatomies taught brilliantly in medical school already you really learn there now to be very well and it’s repetitively taught throughout the years that you’re in medical school more where I think I would make a change in curriculum is how doctors deal with death and how they think about death and mostly how they certify death because one of the things that always strikes us is when one of our clinical colleagues you know someone who’s not a pathologist signs a death certificate it makes no sense because they don’t think the same way and no one ever taught me how to do a death certificate in medical school the first one I signed I was an OBGYN resident I had no idea what to put on it you know and now as a medical examiner it’s easy because we think a certain way we think the way that it has to be filled out so I would certainly teach death certification I would teach management of death it’s a part of dealing with a patient treating a patient and it’s also a part of being a doctor you know you have to deal with death and a lot of them don’t so I think I would also think like to incorporate dealing with you know managing it learning to live with it is that something that took a long time to learn the last steel the learning to manage does it kind of came naturally for me I think it’s one of the reasons why I knew this field was for me because I sort of see it all as a cycle I and I think that that might partly be based on religious belief but also just on the fact that you know it’s part of life you live and you talk for other people though that has love you know for people who treat patients it has a different sort of feeling to it you know to them it’s a failure to me it’s not dr. Roman emphasizes that medicine and science will make you a perpetual student I think that very early on you know what you’re doing enough to do the job adequately but every single day that you do this job more knowledge and more experience gets funneled in and I think of myself a decade ago and myself today and we’re very different people I was competent I did well enough ten years ago I’m much more confident now and I’m sure that in another decade providing I don’t get demented or something I will continue to become even more experienced and more competent that’s the beauty of medicine it grows on itself you know it’s endless that’s the beauty of it there’s no knowing at all so the longer you do it the better you get at it and the more you learn in the more you see and the more you do so that’s a detailed look at the life and experience of a forensic pathologist but we know what you’re thinking how much money does the job pay for an experienced any such as dr. Roman the job pays about one hundred fifty six thousand dollars per year in New York City there are generous benefits for vacation days sick days and retirement if you are interested in a career as a forensic pathologist start hitting the books remember that you will have to go to college and then Medical School I’m Hannah reporting for TV n