More Autopsies?
The American Medical News published a letter to the editor that was so weird that I have to repeat it here:
Liability concerns are reflected in nation’s low autopsy rate
Regarding: “Declining autopsy rates affect medicine and public health” (Article, Feb. 20):
The fact that only 9% of all deaths in the U.S. were autopsied in 2007 is highly disturbing, especially since a large study in 2005 revealed that approximately 50% of autopsies revealed findings that were unsuspected prior to the patient’s demise.
The reasons for this continuing downward trend and the significant adverse consequences have been repeatedly commented upon. From medicolegal and forensic scientific perspectives, the likelihood of serious consequences and grave injustice in both civil and criminal matters is quite apparent. Educated, intelligent, sensitive people like experienced physicians should be fully aware of these tragic ramifications.
As both a hospital and forensic pathologist, I have been amazed by the frequency of cases in which the attending physician literally attempts to dissuade a family from having an autopsy performed. “It’s not necessary. We know everything already” to “Why should you want to have your loved one cut open?” are among the kinds of comments I have encountered personally.
I believe that the principal factor responsible for this unacceptable decline of autopsies was not referred to in this otherwise informative article. Fear of a malpractice lawsuit — that is the primary reason that doctors do not want autopsies to be done.
In the absence of a thorough postsmortem examination by an experienced pathologist, the cause of death will be officially designated by the diagnosis set forth by the treating physician. This is the regrettable and harsh explanation for this scientifically deplorable and societally unacceptable philosophy.
–Cyril H. Wecht, MD, JD, Pittsburgh
What? Is he saying that we should do more autopsies so we can have more lawsuits? Let’s just crank up the costs of healthcare even more while we are it. Oh, and yes, he is a lawyer as well as a forensic pathologist. According to Cyril, there are more and more doctors trying to stop families from doing autopsies because they are covering up their tracks. Are you kidding me? I have treated over 100,000 patients and I can only think of a handful of autopsies that were done or NEEDED to be done. That is much less than the 9% performed right now. And trust me, I am not covering up my tracks.
It just seems to me that this letter to the editor was the most self-serving commercial I have seen in a long time. To use his phrase, I would call his correspondence “scientifically deplorable and societally unacceptable”. It sure looks like Cyril needed something to do after he resigned from his position as Allegheny County medical examiner after being indicted on corruption charges. After a hung jury let him walk I expect we are to see some more letters in the future. Maybe he can reply to this blog?
because the messenger is biased in some way should not prevent a careful examination of the message !while 50% may be overkill (pun intended)what does the medical community have to lose ?? consider:
1. the knowledge gained from further information (see other commentator). what if the cod was a condition previously unknown within the family ?
2. identification of malpractice or medical errors where they occurred ! what are you guys afraid of ? if someone screwed up ALL should know about it, measures taken to insure it does not happen again, and compensation paid.
I am not even sure what the issue is. Most questionable deaths have posts on them. Young, weird, suspicious, out of ordinary, etc all get looked at. The real issue is why increase the cost of medicine to do a post on more? Show me the studies showing that doing this gave us enough new information that made it worth it. Until then, case closed.
I am actually surprised at Farrago’s take on this because has been 100% on since I first started to enjoy his writings. The autopsy is a valuable feedback loop for the continuing improvement of our profession. Do we really think we have come so far with our fancy tests to alleviate the need for this? The post-mortem exam is a critical part of the cycle of medicine and I can’t believe that any physician would disagree with that. The lack of performing these appears to be cost (state funding is way down) and interest (the perceived value has fallen).
I try to get medical examiner reports on all poisoning cases in our state as all US deaths reported to poison centers need to be abstracted. I am shocked at the attribution of death in cases without an autopsy! I think if we knew the true number of people who have been maliciously poisoned we would be mortified.
I am not anti-autopsy by an means. Please read my comments in context with the letter written to the AMNews. Increasing the number to 50% is INSANE and way too much overkill (no pun intended).
My family requested that no autopsy be done on my father after he passed away the day after he was released from the hospital. It turns out that in retrospective it was a bad move on our part.
So as not to confuse issues I will give you a brief timeline.
On Tuesday he saw his urologist, a senior physician at the local hospital. The physicians nurse, a senior nurse at the local hospital, suggested that my father see a cardiologist to check for a potential circulatory problem in his leg that may be the source of his leg pain. The next day my father went to the hospital after kneeling down to pick something up and being unable to get up due to leg pain. In the emergency room I relayed the information that one of their senior nurses only the day before suspected that my father had a circulatory problem. Three days later he was released and was not experiencing any leg pain. He was told that he needed bed rest and physical therapy to strengthen his legs. The following day he was found dead in the bathroom.
A few months later I obtained his treatment documentation from the hospital. He received IV fluids which raised his blood pressure (he was slightly dehydrated and his blood pressure was slightly lower than it should have been). This in turn may have dislodged a blood clot from his leg which could have been disclosed with an autopsy. It turns out that despite the fact that he received x-rays, an MRI’s, and a Cat scans from head to toe, in what seems to be a search for him having a stroke, which he didn’t, the hospital did no testing for a circulatory problem in his leg (which was x-rayed). This was the conclusion of the physician that I had reading the report.
We have not sued and probably will not but I’m thinking about meeting with the Hospital to get them to change policy to be more aware of blood clots.
And by the way, it’s not lawsuits that are driving up insurance rates, it’s the greedy insurance companies. If we had a low overhead government sponsored medical insurance program we could drastically lower the cost of medical care.
Regardless of the messenger, the message “approximately 50% of autopsies revealed findings that were unsuspected prior to the patient’s demise” may indicate a problem. Without evaluating this message (i.e. if we reject it out of hand), we cannot know if it indicates endemic malpractice or trivial unreported complications. Anyone with access to the statistics used by the messenger referred to in this post care to analyze the raw data?
Of course not.
You’re missing his point, which is: if we did more autopsies, nobody would die. Or maybe: if we knew every conceivably possible cause of an individual’s death, they would come back to life. Maybe it’s because I’m 77, and coming around third, that I see more and more evidence of people denying the boring but scary inevitability of death.
Cyril Wecht is a conspiracy nut. He was the leading conspiracy theorist of the Kennedy assassination. Look up his history and you’ll see what a wacko this guy is…..