The death of the autopsy

In 1975 there were 150 autopsies at Salem Hospital; this year there were 14. This precipitous decline is not unique to Salem; this drop-off is a national phenomenon.

Most of this is due to improvements in the medical armamentarium. With CT's and MRI's so commonplace, one no longer needs to open a body to find out what is ailing the patient. Additionally, laboratory testing is more sophisticated, employing techniques such as PCR, ELIZA, antibody testing, and cytogenetics in the diagnosis of human disease. And our knowledge about many diseases is increased. In summary, less people are dying of unknown causes.

However, part of the decline in autopsies is financially motivated. There is no charge for an autopsy; the hospital eats the cost. In an era of budget cuts and HMO's, there is little incentive for hospitals to perform autopsies. And while families are often comforted knowing the cause of a loved one's death, an autopsy can sometimes provide ammunition for a law suit.

Most pathologists do not mind this decline, in fact many are downright thrilled by it. An autopsy is labor intensive, both in the time and physical effort required. They are messy and frequently unsatisfying as even an autopsy can fail to uncover the cause of death. There is little compensation for the task. And with increasing cancer rates, pathologists have plenty else to do to keep them busy.

But for the purist, the decline in autopsies is unsettling. Most of our knowledge about disease originates from autopsy findings. An autopsy provides an opportunity to admire human anatomy and get back to "hands on" medicine (and make a bloody mess all in the name of science!). And despite all of the improvements in medical technology, there are still many cases where the cause of death is only discovered at the time of autopsy.

I don't expect hospital autopsies to ever pick up again. In fact, I suspect that they will die out all together with occasional hospital cases being sent off to the medical examiners. However, I don't expect that the truth in this pathology cartoon will ever be completely gone: