Legacy Matters

Are we burying answers?

We may be burying our best medical lessons by not doing enough autopsies writes David Dobbs in Buried Answers in the New York Times magazine.

Autopsy is the most powerful tool in medicine, responsible for most of our knowledge of anatomy and disease says Alan Schiller, chairman of pathology at Mt Sinai School of Medicine in New York.

Neglecting the autopsy is anathema to the whole practice of medicine.

In the 1960s, almost 50% of all deaths were autopsied, today the number is less than 5%.  Dr. George Lundberg, a pathologist who edits the online medical journal Medscape says nothing can reveal error like an autopsy and by revealing mistakes, help doctors learn and advance the cause of medicine.

Only an autopsy can reveal whether a patient died of Alzheimer's, or multi-infarct dementia or encephalitis or even a variant Creutzfeldt-Jakob prion killing disease.  What a patient really died of has enormous significance for their survivors.  The real cause of death can reveal what the surviving family can take preventative action against.  In many cases, an autopsy can provide the family with a "welcome sense of resolution.... ease anguish about things done or not done"

Reliance on diagnostic tools before death like CAT scans and MRI's instead of autopsies only buries the real answers.

One of my own family doctors told me that he rarely asks for an autopsy because ''with M.R.I.'s and CAT scans and everything else, we usually know why they died.''

This sense of omniscience, Lundberg says, is part of ''a vast cultural delusion.'' At his most incensed, Lundberg says he feels that his fellow doctors simply don't want to face their own fallibility. But Lundberg's indictment is even broader. The autopsy's decline reflects not just individual arrogance, but also the general state of health care: the increasing distance and unease between doctors and patients and their families, a pervasive fear of lawsuits, our denial of age and death and, especially, our credulous infatuation with technology. Our doctors' overconfidence, less bigheaded than blithe, is part of the medicine we've come to expect.

So there's one more thing you can do for your family - insist on an autopsy as part of your last wishes.    You'll be advancing the cause of medicine at the same time.