I grew up watching a lot of TV. Dad was in charge of the remote, so what he wanted to watch, we all watched.
As a result, I spent many evenings watching Jack Klugman (best known for playing Oscar Madison in The Odd Couple) on Quincy, ME. Quincy’s job as a medical examiner in Los Angeles always drew him into fascinating whodunnits that were neatly wrapped up in an hour. He always solved the mystery just as his naysayers were about to lower the boom.
Television in the 70s and early 80s was often an exercise in suspended reality (Remember The Six Million Dollar Man?). Quincy is one example because all the ladies he met seemed to think ‘ole Quince was a real catch. Frankly, I think they were just after his houseboat.
Watching Quincy gave me the impression that autopsies were a common procedure. With current TV shows like CSI and Law and Order, this impression has not only been upheld but encouraged. In reality, that’s not the case at all.
The word autopsy comes from the Greek “autopsia” for the act of seeing with one’s own eyes. It’s an examination of a body after death to determine the cause of death or the character and extent of changes produced by disease.
Autopsies are not done only on murder victims but to determine what disease or health factors led to a person’s demise. They often turn up nothing unusual at all. Or they can discover something major.
Laws vary from state to state but in most cases, with consent from a patient’s next of kin, a doctor can order a clinical autopsy to determine the disease process in the body and determine cause of death. That was the norm 50 years ago and in Quincy’s era.
“Much of what we know about medicine comes from the autopsy,” said Dr. Stephen Cina, chairman of the forensic pathology committee for the College of American Pathologists, in a 2011 article. “You really can’t say for sure what went on or didn’t go on without the autopsy as a quality assurance tool.”
So why are fewer autopsies being performed?
In 1971 The Joint Commission, which accredits health-care facilities, told hospitals they were no longer required to conduct autopsies to keep in good standing. Before, mandated autopsy rates of 20 percent were in place for community hospitals and 25 percent for teaching facilities. Now, some hospital autopsy rates are down to zero.
Hospitals also have considerable financial incentives to avoid autopsies. An autopsy can cost anywhere from about $1,500 (performed by the hospital at the medical examiner’s request) or if it’s done privately at a family’s request, $2,000 to $5,000. Medicare and private insurers don’t pay for them directly, typically limiting reimbursement to procedures used to diagnose and treat the living.
In addition, autopsies can be difficult to perform, physically demanding and time consuming. Many hospitals would rather their time and money be spent elsewhere.
As a result, it can be difficult for a family to get an autopsy performed on a loved one if the medical examiner won’t do it. The cost then falls to them to have it done privately.
Such was the case in 2013 when the family of Arizona woman Jessie Tolly demanded answers after her sudden death. The medical examiner blamed Jessie’s death on her obesity and refused to authorize an autopsy.
Tolly’s family hired a private pathologist to perform the autopsy at the cost of $2,000, which revealed the cause of death to be a defective heart artery. Tolly’s mother was furious when she later discovered the medical examiner’s office contacted that pathologist for a copy of the report, bypassing the family entirely.
“We’re not rich, we don’t have a lot of money and we’re just middle income, you know, I felt in many respects that, in their minds, she just didn’t rate,” said Tolly.
Another reason doctors are requesting fewer autopsies is because of their reliance on today’s diagnostic tools like CT scans and MRIs, which can identify ailments while patients are still alive.
But according to the previously mentioned 2013 article, studies of autopsies have revealed that doctors can still make a number of diagnostic errors even with increasingly sophisticated imaging equipment.
A 2002 review by the federal Agency for Healthcare Research and Quality showed that when patients were autopsied, major errors related to the principle diagnosis or underlying cause of death were found in one of four cases. In one of 10 cases, the error appeared severe enough to have led to the patient’s death.
The importance of autopsies goes beyond determining cause of death. They can also be a critical tool for evaluating and improving medical care.
Dr. Elizabeth Burton, deputy director of the pathology department at Johns Hopkins University School of Medicine, said performing autopsies on patients who have died of hospital-acquired infections helps save others. Doctors have used her research as a basis for changing antibiotic regimens.
Finally, autopsies can help family members learn whether a relative died from an undiagnosed or misdiagnosed illness or disease that may be hereditary.
Dr. Gregory J. Davis at the University of Kentucky College of Medicine (according to a recent Frontline documentary) said 40 percent of autopsies performed in the U.S. reveal disease states previously unknown to physicians, largely because the autopsy involves techniques that can’t be used on the living.
There continue to be a variety of opinions on the value of autopsies today. Because I am nothing close to a medical expert, I can only share what I’ve learned. But I hope it gives you a clearer picture of why autopsies are now increasingly rare but can still be incredibly helpful when they are performed.
I hope Quincy would be proud.