The declining autopsy rate is certainly not a new phenomenon but it occasionally crops up in the news, as in the following article (see: The Incredible Shrinking Autopsy)
The autopsy isn’t dead, but it’s certainly on the decline. New government stats show that in 2007, an autopsy was performed for just 8.5% of deaths. That’s down from 19.3% in 1972. (The low was in 2003, with just 8.1% of deaths involving an autopsy.)....In the case of disease, autopsies can not only pinpoint the cause of death, but also reveal “clinically significant diagnoses that were missed before death,” as well as “generate more accurate vital statistics, provide pathological descriptions of new diseases, and offer powerful tools for education and quality assurance,” according to a 2008 Perspective piece in the New England Journal of Medicine. Most (91%) of deaths in the U.S. were due to diseases in 2007, and those are the cases where autopsies are dropping. That year, autopsies were performed for only 4.3% of illness-related deaths, compared to 55.4% for deaths from external causes like assault or poisoning and 29.1% of ill-defined or unknown causes....“There’s a general perception that it’s less needed because we have more diagnostic techniques,” [according to an author of a recent report]. With sophisticated imaging, for example, the cause of death may seem obvious....The cost of an autopsy is also a factor in its decline, as we noted a few years back.
As I have observed in previous notes, the only way to reverse the declining autopsy rate is to integrate modern imaging technology into it with the virtopsy (see: Introducing the Virtopsy, a Variant of the Catopsy Theme; The Classic Forensic Autopsy on the Verge of Being Obsolete; Additional Discussion About Reinventing the Autopsy; Reinventing the Autopsy: CT Imaging as a Routine Part of the Procedure; NYT Highlights the "Virtopsy" Used for All Military Autopsies). The virtopsy would undoubtedly be more accurate than the classic autopsy. It also could be performed less expensively and more quickly. You can refer back to my previous notes for more details about its advantages. It is currently the norm for the U.S. military and also widely adopted in countries such as Switzerland.
As noted in the excerpt above, one of the major reasons for the decline in the autopsy rate is that it's time-consuming and thus expensive. It's also an uncompensated hospital service. Needless to say, family members are also often reluctant to allow the procedure on relatives without a compelling reason. This is commonly a desire to obtain more detailed information about the cause of death. Such family attitudes were prevalent even when the autopsy rate was much higher. However and in previous times, a high autopsy rate for a hospital was a quality indicator so that the house officers and staff attendings in teaching hospitals pushed harder for permission. Now, there is much less pressure for them to do so.
I believe that the likelihood for a major adoption of virtopsies in hospitals in this country is close to zero. The reasons for my opinion are the following:
- The autopy/virtopsy would continue to be uncompensated by the various healthcare payers in the face of unrelenting pressure to reduce the cost of care.
- Large capital costs would be incurred if CT scanners were installed in hospital autopsy suites. The request for such expenditures would not be able to compete with revenue-generating activities.
- Pathologists will oppose a major shift to virtopsies because they would continue as an uncompensated service. Also, few pathologists would be able interpret the CT images that would become an essential component of the virtopsy.
- Sophisticated medical imaging is becoming much more prevalent for all inpatients providing, in effect, an antemortem virtopsy.
In short, the autopsy will rate will continue to decline. Some will continue to be performed in teaching hospitals to train pathology residents and for forensic cases.
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