TUESDAY, Jan. 28, 2003 (HealthDayNews) -- The dead have many things to tell us, but we're not tuning into their messages.
This failure to communicate has nothing to do with seances. The problem is with autopsies -- or lack of them.
A new report says there's been a dramatic decline over the past few decades in the number of autopsies done in the United States. That means the loss of valuable medical information that could improve health care for the living.
The report is based on an analysis of more than 50 studies on autopsies over 40 years. It found the autopsy rate for all non-forensic deaths (those that don't involve the law) in the United States fell below 6 percent in 1994 (the last year for which national data exist), compared to 50 percent in the 1960s.
Using information from their analysis, the researchers estimated that in American hospitals in the year 2000, the lack of autopsies meant the correct cause of death eluded clinical detection in 8 percent to 23 percent of deceased patients, with as many as 4 percent to 8 per cent of all dead patients having a missed diagnosis that may have harmed them.
The report also found that as many as 5 percent of autopsies revealed clinically unsuspected complications caused by medical care.
It was prepared for the U.S. federal Agency for Healthcare Research and Quality (AHRQ) by the University of California at San Francisco (UCSF)-Stanford University Evidence-based Practice Center.
The report examined the benefits of the autopsy as a method of health care performance measurement and improvement and explored the potential negative effects of the trend towards fewer autopsies.
It didn't focus on using autopsies to point fingers at doctors and other health-care professionals about mistakes. The authors approached this as a public health concern -- that facts gleaned from dead patients can provide precious knowledge that will improve overall health care.
"The bottom line is that the autopsy is still much more important than we thought," says lead author Dr. Kaveh Shojania, assistant clinical professor in UCSF's department of medicine.
He says that in the 1950s and 1960s, autopsies were done on a third to a half of all patients who died in American hospitals. Now, many American hospitals do few or no autopsies.
"Why it's happened is actually a complicated story. It's not a single answer," Shojania says.
Many health-care professionals don't see the need for autopsies, he adds. They feel that modern medical technology accurately reveals the cause of death in the majority of patients.
"Even though that's widely believed ... there's hundreds of studies out there ... showing that there's substantially high rates of what you might called diagnostic surprises or errors," Shojania says.
Those studies show that autopsies sometimes reveal the cause of death to be quite different than conclusions based on information from medical technology.
There are other factors. Hospitals don't get paid for doing autopsies, so there's no financial incentive to do them, he notes.
Many pathologists view autopsies as consuming valuable time that can be used doing tests that benefit the living. And many pathologists are more interested in the high-technology, laboratory-based aspect of pathology, rather than, "mucking around in a dead person's colon," Shojania says.
"I guess the major message is that the report indicates that the autopsy, which has fallen out of fashion, is still a very valuable resource for several reasons," says Dr. Paul Raslavicus, president of the College of American Pathologists, which requested the AHRQ to produce the report.
Raslavicus agrees that autopsies can play an important role in improving public health. That's because autopsies help track the true incidence of disease and the accuracy of death certificates.
Also, doctors, nurses and other health professionals can benefit from autopsy findings, which may provide them with new insights and knowledge to help them provide better treatment and care for their patients.
"There's an old saying that the dead teach the living," Raslavicus says.
He agrees that a major factor in the decline of autopsies is the belief that current medical technology can detect all the important medical information about a person, including the cause of death.
There's also increasing demand from many different areas of medicine for dwindling health-care dollars.
"Something has to go. And the autopsy seems to be sort of the orphan child," Raslavicus says.
He says many morgues are in poor shape and require improvement and modernization. However, that is just not seen as high a priority compared to, for example, equipping or building a new operating room.
More information
You can learn more about autopsies here or from this BBC article.
