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Autopsies--Are They Really Important in This Era of High-Tech Medicine?

Back in the days of low-tech medicine (i.e., the 1960s), the percentage of autopsies on patients dying in our university teaching hospitals was about 50 percent--and the autopsy rate was an important factor used by accrediting bodies in rating the overall quality of medical care in hospitals. Today, the autopsy rate has dropped to an average of 10 percent in teaching hospitals and as low as 5 percent in community-based hospitals. Does this mean that our high-tech medicine no longer requires postmortem exams to verify the cause of death?

As a report in the October 14 issue of the Journal of the American Medical Association (JAMA) shows, the answer is a definite no. Despite technological advances, the number of inaccurate clinical diagnoses (for cancer and all other causes) remains high. A review of 1,625 autopsies of patients dying at the Medical Center of Louisiana, New Orleans, from 1986 to 1995 showed a 44 percent disparity between the prediagnosis of the cause of death and the diagnosis determined by autopsy. Altogether, 433 neoplasms (abnormal growths) were diagnosed at autopsy, 250 of which were malignant. One hundred and 11 of these cancers had either been undiagnosed or misdiagnosed--and this in a university medical center.

This 44 percent disparity between clinical diagnosis in dying patients and what postmortem examination revealed is not unusual---in fact, it has not changed much in the past 75 years! What the study reveals, as an editorial in the same issue of JAMA states, is that "there is a giant gap between what high-tech diagnostic medicine can do in theory in ideal circumstances (very much, very well) and what high-tech diagnostic medicine does do in practice in real-life circumstances (not nearly so well), when human beings have to decide what, when, how, and why to use it.... Low-tech autopsy trumps high-tech medicine in getting the right answers again and again, even during the 1990s and even at academic medical centers."

There is no obvious explanation for the steady decline in autopsies in the past 30 years. One possible reason is their cost, and with rapidly rising costs of medical care, doctors have apparently been reluctant to press patients' families for autopsies--and most families don't want their loved ones subjected to an autopsy. However, if we are to have accurate statistics on the incidence of various diseases, and especially those like cancers that have fatal consequences, autopsies are the only sure way of identifying the cause of death in many cases.

The vast majority of deaths in the United States occur in persons for whom the cost of an autopsy is covered by a third party (75 percent of patients who die are under Medicare, which pays for autopsies, and an additional 12 percent of cases are coroner or medical examiner cases.) There is thus no financial excuse for failing to do autopsies in such patients. The family of a Medicare patient has a right to an autopsy and to have its results.

Knowing for certain what diseases have caused the deaths of one's family members is especially important when those diseases may have implications for other members of the family. A family history of certain diseases alerts doctors to look for signs of those diseases in other members of the family, when early detection may be the key to adequate treatment. If your doctor fails to ask permission for an autopsy on a family member, demand that one be done. The information an autopsy can provide may save your life.
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Author:E.B.
Publication:Medical Update
Date:Jan 1, 1999
Words:583
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