Pathologist Mark Pool commented on my recent note regarding the value of the classic autopy and the adoption of the virtopsy as an improved form of the procedure (see: A Clinician Laments the Decline of the Autopsy). His comment was so useful that I decided to promote it to the level of a note. It is presented below in its entirety:
Thanks...for another provocative post on the autopsy. I guess I'll take the bait! The subject of this post reminds me of a saying I used to hear as a boy: "Two can live as cheap as one, if one don't eat." We talk the talk of wanting to improve quality, but the fact of the matter is that the autopsy (as it is currently) is a time- and energy-consuming endeavor whose value to medicine (as measured by its compensation) it exactly: zero.
Encouraging more autopsies without reforming how our time is reimbursed is reckless and feckless--no matter what it contributes to education and/or quality. While I'm doing the autopsy for Dr. Gompf, she is likely seeing patients in clinic--meanwhile after I drag myself back to my office from the morgue, I still have trays of slides left that I have to sign out. Since I stand astride community and academic practices, I can also attest to the fact that autopsies are equally discouraged and demeaned even in teaching centers. If I hear any hue-and-cry for the autopsy (as things stand now), I'm running for the hills!
With that being said, I agree that the virtopsy would be a brilliant alternative that actually would address several different problems and deficiencies (which can be deduced from your last enumerated points). This could be a ax-handle for our College [i.e., College of American Pathology; CAP] to use if we seriously want to promote evidence-based medicine and improved patient care. As things are now, we get what we pay for.
As far as I can tell, there is no mainstream movement to abolish the autopsy or even reform it. In the face of it being demeaned by pathologists and clinicians alike, I suspect that it will continue to undergo atrophy in community hospitals and persist mainly in academic centers for training pathologists. I don't think that increasing reimbursement for the autopsy would help much if clinicians have gotten out of the habit of ordering the procedure and depending on it as part of their continuing understanding of pathophysiology and treatment.
Mark appropriately links the value of a virtopsy with evidenced-based medicine (EBM). For me, one of the most useful aspects of the virtopsy would be the linkage of the CT images obtained during the procedure with the coded post-mortem diagnoses of the pathologist as well as the post-mortem H&E tissue sections. To the best of my knowledge, our current autopsy reports make little or no contribution to EBM studies. Although I agree that the virtopsy could serve as an "ax-handle" issue for the CAP, the organization's lackluster support for an even more critical issue, digital pathology, suggests that we won't receive much help from this quarter regarding autopsy reform (see: Did the CAP do enough for digital pathology and discussions with the FDA?).