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MORE AUTOPSIES NEEDED
When a plane crashes, everyone looks for the black box. The contents of this box explain all the details that happened prior to the crash. When your body crashes, no one looks for medical answers found in your body’s black box organs. Autopsies have all the answers.
Historically, the cause of death is wrong 30% of the time for major diseases like heart attacks, cancers, strokes, and pneumonia.
THE DOCTOR’S DOCTOR
Up until the 1960s, pathologists played the role of the Supreme Court of medicine, and were labeled the “doctor’s doctor”. After performing an autopsy, they correlated the medical history with their autopsy findings to confirm the cause of death within a reasonable degree.
Residents and interns flocked to conferences, which acted like senatorial subcommittees, all discussing the various ramifications of the patient's illness.
The attending doctor, whose patient was being discussed, filled in details of his treatment. The house staff became aware of the various possibilities of treatment after reviewing lab tests and symptoms. Often the last 2 to 3 days of illness, resulted in many surprises for doctors. These conference resulted in better training and provided better quality medicine.
THE NEED FOR EXCELLENCE
The quality of a hospital was gauged by the percentage of autopsies it had performed in a given year. The house staff, interns, and residents were well aware of the need to obtain an autopsy, as this affected their hospital ranking
WHAT CAUSED THE DEMISE OF AUTOPSIES?
Hospital rates were around 50% of all deaths in the 1950s, and a minimum of 25% autopsies were required. Today it’s about 5% in community hospitals, and fewer than 10% in University hospitals. Lack of money, lack of standards, worry over legal liability, and even today, the lack of trained pathologists who can do autopsies, are all reasons for the decline.
It all started in 1971, with a decision by the Joint Accreditations for Hospitals to eliminate minimal autopsy requirements from hospital accreditation regulations
Health insurance companies had weaved the cost of autopsies into hospital reimbursable expenses to pay for the autopsies. Cost-conscious HMOs refused to cover them, even in malpractice cases. They focused on financial healthcare, and only would reimburse the cost of getting someone well.
75% of deaths in this country are Medicare deaths. Medicare refuses to pay a professional service for these procedures to hospitals and physicians. Government funding of high-tech research has reduced the value of autopsies as a research tool for hospitals.
Government insurance programs, Medicare, Medicaid, all disbanded their support for autopsies. Our cost-conscious insurance companies see autopsies as money losers. Medicare also pays a fixed amount to hospitals, bundling patient payments and do not earmark these funds specifically for autopsies. The pathologist no longer saw these funds. Managed care also tell us that autopsies are built into the hospital contracts. They will not reimburse the patience family unless they are convinced it is of value. Well, administrators can’t get federal grant money for doing autopsies.
Pathologists have become businessmen, and govern huge laboratory screening centers, chemical biologic cancer markers, Pap smears, and their bread and butter biopsies.
Their autopsy rooms often have not been used for the past 50 years. They are located in the basement of hospitals, rarely opened and certainly not modernized.
With the advent of imaging tests (as CAT scans, MRIs, pet scans), insurance companies no longer feel an obligation to pay for autopsies. Hospitals are coerced into thinking the information they get from all the testing and imaging are enough to reasonably presume the cause of death.
IS THERE REALLY A NEED FOR AUTOPSIES?
With so many bypass surgeries performed, stent implantations, pacemakers, and ontological cancer treatments, we certainly lack many medical answers.
Did the bypass surgery really open up coronaries?
Was the pacemaker functioning?
Did the stent fragment, breakup, and lodge in the lungs?
Did the patient truly have hardening of the arteries?
Did Grandpa have Alzheimer’s or did he get many mini strokes to the brain that were unrecognized?
Was there an ongoing unrecognized infection in the kidneys?
Did the liver quit functioning?
How well did the anti-cholesterol drugs work?
What side effects occurred to many of these organs after taking multiple drugs?
DOES IT REALLY MATTER?
Certainly doctors do not care to have their medical treatments questioned. If the facts came out, what percentage of doctors would be sued?
Without tort reform,is it better to bury one’s mistakes?
Do drug companies want to know that their medications did not work?
Do radiologists want to know that they missed some tumors in their imaging readings?
Do medical device manufacturers want to know the malfunctions of their device?
Does the hospital want to know truly where it stands in its medical ranking?
Do the trial lawyers want to lose their clients?
THE OBAMA QUEST FOR QUALITY MEDICINE
The White House, after running a series of retrospective studies, have questioned the value of certain surgical procedures, drug therapies, and imaging tests, as MRIs?
The administration feels they can remove 30% of the procedures being now done, limit patient hospitalizations and re-hospitalizations, endorse generic drugs over prescription drugs, and eliminate certain procedures as colonoscopies, laparoscopies, and cardiac catheterizations. All this is in the name of removing waste from Medicare.
Retrospective studies, as poll taking, can always be twisted. Their statistics is like garbage, easy to collect, and hard to get rid of. Far better, and less costly, would be to put our pathologists back in the autopsy room to tell us what really happened, and what was really medically necessary to prevent the death of your loved one.
To return autopsies again to their rightful place in medicine, insurance companies and government health insurances, must begin again to pay for these procedures. The results obtained and the costs incurred, will be certainly much less than the many ambiguous retrospective studies now being done.
Secondly, tort reform is essential to obtain the cooperation of the medical doctor and hospital staff.
And in the end,” the truth will set you free!”.
COMMENTARY
Autopsies verify the cause of death and determine what was wrong and what was missed. Problematic cases must be investigated for training, education and research purposes. Autopsies must again monitor the effect of therapy, especially new drugs, and the reliability of new diagnostic procedures and will benefit patient’s families, hospital staffs, and the future of medicine.
Unexpected findings can be uncovered, that will be of great benefit to the continuing education of doctors and nurses. Mortality can be studied in more detail, and we can certainly learn more about living from the study of the dead. It will make clinicians diagnose diseases more accurately, and improve their therapy.
Autopsies tell us the true cause of death. Today doctors sign death certificates saying the immediate cause of death was heart failure, secondary to cerebral anoxia, and secondary to whatever the admitting hospital diagnosis was.
SOURCES
Am J Med 1986; 80:665-67
J Clin Pathol 1987; 40:459-461AMA 1987; 258:364-369. 1
Scripps Howard News Service’s seven-month review of 4.9 million deaths in the United States in 2005 and 2006.
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