Institutional Reporting

Autopsies as an example

An overwhelming portion of what is known about our bodies and diseases was discovered through autopsies. Autopsies might be the greatest learning and error prevention tool that there is in medicine. Stiff: The curious lives of human cadeavors, by Mary RoachWhen autopsies are done they uncover missed or incorrect diagnoses in up to 25 percent of hospital deaths, but hospitals don't like to discover mistakes. And they don't like expenses that do not generate profits. So they don't do autopsies much. In the 1940s, about half of Americans who died in hospitals were autopsied. The rate now is less than 5%. They have been pressured to do more, but consistently found ways not to. That is a refusal to find or report information essential to the wellbeing of patients.

(JCAHO, pronounced Jayco) tried to get hospitals to autopsy suspicious on unexplained or unusual deaths in order to learn from them. To try to encouraged that they used to require that 20% of hospital deaths be autopsied. But hospitals circumvented JCAHO's efforts by doing only random autopsies, rather than autopsies of cases where things went wrong or otherwise were not well understood. That way less evidence was created of most of the problems. They were able to meet JCAHO's 20% requirement without finding most of the problems. Eventually JCAHO gave up and dropped the requirement, which is too bad because even the random autopsies would have taught us something. I guess that lends some credence to the critics who say that JCAHO is more lapdog than watchdog.

Another major study examined 1000 autopsies between 1983 and 1988 and found that there were "'major discrepancies' between the autopsy findings and the clinical diagnosis in 317 cases." But now that we do so few autopsies, we'll never learn where those errors are in order to avoid making them again and again. The people committing those errors will not learn what they are doing wrong. They will keep making the same mistakes over and over. We also will be less likely to discover the injuries that were not errors.

Military Autopsies

Since 2001 all military casualties have been given autopsies. Since 2004 they also have been getting CT scans. One of the things discovered as a result was that one of the reasons soldiers were dying was that when soldiers had a collapsed lung, the tube medics were using to treat them was too short. Fifty percent of soldiers with collapsed lungs died because the tubes inserted into their chests was too short. Soldiers today are bigger than soldiers were in the past. So the military now makes the tubes longer.

Civilians patients are more obese than they used to be. Civilian patients are of a different mix of ethnicities than they used to be. Many things have changed about the civilian patient population. But we are not doing autopsies on civilian deaths to determine why so many are dying unnecessarily in medicine every year. Maybe the well-being of patients isn't really their highest priority.

Part of the reason the military began doing the autopsies was the need of the families to have a full accounting of the deaths of their loved ones. Ever try to get that for a civilian casualty in a civilian hospital?

Shouldn't the well-being of survivors be on the list of priorities for civilians too?