Abstract
There has been a notable decrease in the global practice of clinical autopsy; the rate has fallen to below 10%, even in high-income countries. This is attributed to several causes, including increased costs, overreliance on modern diagnostic techniques, cultural and religious factors, the emergence of new infectious diseases and negative attitudes on the part of doctors, even pathologists. Alternative methods to autopsy in postmortem studies have been developed based on imaging, endoscopy and biopsy (all quite expensive). These methods have been used in developed countries but never as effectively as the classic autopsy for identifying cause of death and potential medical errors. Although Cuba has also seen a decrease in its autopsy rates, they remain comparatively high. Between 1996 and 2015, there were 687,689 hospital deaths in Cuba and 381,193 autopsies, 55.4% of the total. These autopsies have positively affected medical care, training, research, innovation, management and society as a whole. Autopsies are an important tool in the National Health System's quest for safe, quality patient care based on the lessons learned from studying the deceased. KEYWORDS Autopsy, postmortem examination, postmortem diagnosis, quality of care, patient safety, medical error, Cuba.
Highlights
Despite the valuable information that postmortem examinations can provide, global rates of clinical autopsy have significantly decreased in recent decades
Shojania and Burton have argued that pathologists are increasingly preferring to spend their time on new and sophisticated molecular diagnostic tests conducted on tissue biopsies of living patients rather than on autopsy, which has barely changed over the past century.[3]
The decreased autopsy rate in the USA is partially due to lack of incentives to perform them: In 1971, the US Joint Commission on Accreditation of Healthcare Organizations eliminated the requirement for a minimum autopsy rate for hospital accreditation, and in 1986, Medicare stopped paying for autopsies.[3]
Summary
Despite the valuable information that postmortem examinations can provide, global rates of clinical (nonforensic) autopsy have significantly decreased in recent decades. This is a reflection of a clear trend to reduce their importance.[1] This can be attributed to different factors. Shojania and Burton have argued that pathologists are increasingly preferring to spend their time on new and sophisticated (and more profitable) molecular diagnostic tests conducted on tissue biopsies of living patients rather than on autopsy, which has barely changed over the past century.[3] These authors identify two factors that explain diminishing interest in clinical autopsy: the incorrect belief that new technology has rendered autopsy obsolete, and doctors’ general aversion to asking family members of the deceased for consent to perform autopsy.
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