[Mb-civic] The_value_of_autopsies - Boston Globe Editorial
swiggard at comcast.net
Mon Jan 2 05:43:45 PST 2006
The value of autopsies
January 2, 2006
SIX YEARS AGO, the federal Institute of Medicine deplored the annual
toll of 98,000 deaths caused by errors in US hospitals. Since then,
progress has been made in some approaches to curbing medical mistakes,
but there has been little advance in one of the best correctives: more
routine use of autopsies.
Autopsies are a low-tech but highly effective way to learn answers to
medical puzzles that MRIs and other imaging devices often cannot
explain. Until the 1960s, nearly half of all patients who died in
hospitals were autopsied, but the rate has fallen below 5 percent now.
No campaign to improve healthcare will be complete without a concerted
effort by the major hospital accrediting agency and Medicare to ensure
that this quality-control check is used more often.
Autopsies are routinely done by state medical examiners in cases of
crimes, accidents, and many deaths that occur outside of hospitals.
Recently, the state's new chief medical examiner, Dr. Mark Flomenbaum,
lamented that relatively few autopsies are occurring in hospitals. He
attributed this to doctors' reluctance to broach or press the subject
with family of the deceased.
Everyone would benefit if doctors were more willing to explain to loved
ones how much medicine can learn from this procedure.
In 1999, autopsies in New York City uncovered the first US cases of West
The victims had been misdiagnosed as suffering from St. Louis
encephalitis. More frequent autopsies would also result in earlier alarm
bells if avian flu or some other new and highly contagious disease
arrives on these shores.
Modern diagnostic measures might make autopsies less necessary but not
superfluous, as shown in studies like the one published in 1998 by the
Journal of the American Medical Association. Reporting on 1,100
autopsies done over 10 years in New Orleans, the study found that of 250
cancers detected, 44 percent had been undiagnosed or misdiagnosed.
The then-editor of JAMA, Dr. George Lundberg -- a longtime advocate of
greater use of autopsies -- has called physicians' faith in their
technical knowledge "a vast cultural delusion."
An autopsy can also be of use to survivors.
While the procedure may confirm that a middle- aged person died of the
heart attack diagnosed by the physician, doctors might also learn that
the patient was developing, without symptoms, one of the more
inheritable cancers -- a warning to his family.
Historically, the autopsy has been at the center of humankind's
knowledge of how the body works. If the country is serious about
reducing the rate of medical errors and quickly detecting the arrival of
lethal new infections, autopsies need to play a greater role.
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