Saturday, April 23, 2005

Autopsies

The New York Times Magazine has a good article about autopsies.
The rate of autopsies has declined markedly in the last 40 years, partly due to economic pressures:
Hospitals say the problem is money. An autopsy can cost from $2,000 to $4,000, and insurance won't cover it. Most patient families blanch if asked to pay for it, and many can't afford to after paying medical and funeral bills. So the hospital gets the tab. For most of the postwar period up to 1970, hospitals generally paid it, essentially because they had to: the Joint Commission on Accreditation of Healthcare Organizations required hospitals to maintain autopsy rates of at least 20 percent (25 percent for teaching hospitals), which, then and now, is the rate most advocates say is the minimum for monitoring diagnostic and hospital error. The commission eliminated that requirement in 1970. Lundberg says that this happened because hospitals, which had already allowed the rate to drop to close to 20 percent since its 1950's high of about 50 percent, wanted to let it drop further and pressured the commission. The commission's current president, Dr. Dennis S. O'Leary, says it eliminated the standard because too many hospitals were doing poor autopsies -- and often only the cheapest, simplest ones -- just to make the quota. In any event, few hospitals have paid for autopsies since then. Money is too scarce, they say, the needs of living patients too great.
Improvements in medical technology have not eliminated the need for autopsies:
Perhaps the most troubling reason for the decline of the autopsy is the overconfidence that doctors -- and patients -- have in M.R.I.'s and other high-tech diagnostic technologies. Bill Pellan of the Pinellas County medical examiner's office says: ''We get this all the time. The doctor will get our report and call and say: 'But there can't be a lacerated aorta. We did a whole set of scans.' We have to remind him we held the heart in our hands.'' In fact, advanced diagnostic tools do miss critical problems and actually produce more false-negative diagnoses than older methods, probably because doctors accept results too readily. One study of diagnostic errors made from 1959 to 1989 (the period that brought us CAT scans, M.R.I.'s and many other high-tech diagnostics) found that while false-positive diagnoses remained about 10 percent during that time, false-negative diagnoses -- that is, when a condition is erroneously ruled out -- rose from 24 percent to 34 percent. Another study found that errors occur at the same rate regardless of whether sophisticated diagnostic tools are used. Yet doctors routinely dismiss possible diagnoses because high-tech tools show negative results. One of my own family doctors told me that he rarely asks for an autopsy because ''with M.R.I.'s and CAT scans and everything else, we usually know why they died.''
The bottom-line is that autopsies, though useful for quality control and for the detection of emerging pathogens, will not make a comeback unless 1) Medicare directly pays for each autopsy done or 2) the Joint Commission or Medicare requires a certain autopsy rate for hospitals.

4 comments:

James said...

Hi there!

I'm currently researching why people blog about their work - either openly or anonymously, and would like you to complete a quick questionnaire on this subject.

It can be found at:

http://www.my3q.com/home2/62/apr2112/24991.phtml

If you visit my blog you will see some of research findings so far. I have also got links to over 150 work-related blogs on my site and currently you are one of them.

Please let me know if you object to this in anyway.

Thanks for your time and I look forward any response.

James

hospital bills said...

Hi Blogger. Can I find any information on http://www.livechathelp.com here? My friend said to check out Autopsies for information on old hospital bills but this does not seem like the most relevant of blogs. I like cruzing through your site but maybe search engines might have more information. Need to come back later though...great blogs!

Michael said...

Blogger health issues are so important and your Autopsies post is healthy to all Americans and world community. I just wanted to thank you #NAME##. aneurysms , aneurysms and aneurysms are such other disease problems that http://strokescans.blogspot.com is an additional attempt to health prevention. Keep up the great articles and blogs.

Error Doctor 2006 said...

Unclog and Regain Control of Your PC. Visit Error Doctor 2006 Now!