Wednesday, October 7, 2009

A Lost Art

I was at a housewarming party for one of my partners last Saturday night. The contrast between her persona at work and her home is striking. In the lab, she is lighting fast and efficient, attacking her cases and frozens like a sleek tiger. Her home is soft and Victorian; wood floors, marble posts, tasseled curtains, and walls covered in Da Vinci and Degas, framed in ornamental gold.

I was leaning on the granite counter tops eating smoked gouda and brie, talking with two of the gross room techs. The older one has worked in the gross room on and off for thirty years, and was remembering the time when there was at least one autopsy per day, back in the early eighties. By the late nineties, he said the numbers had dropped by 2/3rds. We now average four or five autopsies a year. I have been at my hospital for over two years, and I have performed only one. A stark contrast to the almost 100 I did during my residency training.

I wondered the reasons for the decline in the autopsy, and started asking opinions. I have my own hypothesis: that imaging techniques have become so advanced in the last thirty years that there is no reason to perform an autopsy - I already learned from my training that new information is rarely revealed. Although that is certainly a factor, conversation with other partners uncovered more contributions to the death of the necropsy - no pun intended. Autopsies are very time consuming and there is little reimbursement from medicare and medicaid. If someone dies outside of the hospital, the autopsy is not covered, and when a family member learns that they will have to foot a $1000 to $3000 bill on their own, depending on the state, for a private autopsy, the desire for the procedure quickly wanes. And if you really think about it, do you want your pathologist, who usually works for the hospital, rooting around looking for things that the clinician missed, so that they can be implicated in a lawsuit? Not really, although truth be told, as I said before, radiology and serum lab tests often trump surprise findings at an autopsy.

I was trolling around on my serious path blogs today, and came across on that discussed the virtual autopsy. It is fascinating:

Of course, one place where the autopsy is still very valuable, is the crime lab, where most of path residents get their "autopsy numbers" in order to sit for boards. But I imagine this new technology might bring the autopsy back, if necessary, to gain additional information that may not be easily accessible by traditional methods.

In a way, this makes me a little sad - an old dinosaur eschewing new technology, that may someday replace a time-honored tradition. A tradition that involves more than just the eye - the autopsy engages olfactory, tactile, and visual senses, which all also come to play in the gross room. Even though I still get to examine organs in the gross room, I miss the autopsy. After the diener eviscerates the body, the pathologist is left alone with the block of organs: trachea to internal genitalia and everything in between, tracing pathways and organs to search for the root of the problem, which has often already been determined prior to death, and is merely, in this day and age, an academic exercise.


christie said...

Ah, and autopsy post! Interesting explanations for the decrease in numbers. Makes sense.

Gizabeth Shyder said...

What, are you missing them? Am I disappointing? I'll have to dredge up some resident material for your entertainment. All nicely disguised and fictionalized, of course.