Drop in autopsy rates represents missed opportunities, pathologists say

    In the 1960s, doctors performed autopsies on about half of the patients who died in hospitals. Since then, the rate has plummeted to around 5 percent. Pathologists say that difference represents missed opportunities for gathering accurate medical data, determining just how well current treatments work, and training young doctors.

    Advanced diagnostic testing has given doctors a better sense of what patients are dying from and is part of the reason autopsies have dropped, but some say the battery of tests also gives doctors a false sense of security.

    “Despite all of our medical technology that we have these days and our reliance on it, we still don’t know everything,” said Dr. Robert Ownbey, director of autopsy services at Hahnemann University Hospital.

    Ownbey guesses about a quarter of the autopsies he performs reveal missed diagnoses. His office performs about 150 to 200 autopsies per year for the hospital and other, smaller hospitals that do not have the capacity to perform them. Ownbey said a slew of factors, including more advanced diagnostic testing, declining reimbursements, and fear of litigation have led to the decrease, but that is at the expense of the most accurate medical data.

    “Right now it’s generally accepted in the United States that cardiovascular disease is the No. 1 killer,” Ownbey said. “But with an autopsy rate between 5 and 10 percent in the last several decades, is that really true any more?”

    He said it is probably close to accurate, but it’s not known for sure.

    Dr. Mary Ann Sens, head of the National Association of Medical Examiners, said declining autopsy rates also mean a lack of closure for families and missed opportunities to learn about inheritable diseases.

    “It truly is unfortunate,” Sens said. “The autopsy really helps the living, and when an autopsy isn’t done, there are diagnoses that may be missed, there’s really lost opportunities for the families.”

    In a recent study, Sens found 16 percent of autopsies revealed unsuspected cases of cancer. She said that is evidence that autopsies could improve the accuracy of public health data.

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