Alarm over fall in autopsies

Many patients in intensive care units are wrongly diagnosed, say British researchers who blame a reduction in the number of autopsies.

Some are dying because doctors fail to spot serious illnesses such as heart attacks, cancer and blood clots in the lung, New Scientist magazine reports.

Rather than fingering doctors for incompetence, specialists say that so few post-mortem examinations are performed now that doctors cannot learn from their mistakes.

The drop in autopsies is an international trend that affects New Zealand.

Dr Karen Wood, the New Zealand vice-president of the Royal College of Pathologists of Australasia, said autopsies were common in the 1980s for patients who died in New Zealand hospitals. Now they were rare.

Dr Fang Gao Smith, an intensive care specialist, and her team at Birmingham Heartlands Hospital in Britain checked patients' medical records against autopsy results.

Out of the 38 reports available of autopsies on patients who died in intensive care at the hospital in three years, 15 (39 per cent) showed that major problems were missed. Three had undiagnosed heart attacks.

Ten patients might have survived if the diagnosis was more accurate. Others suffered unnecessarily because of inappropriate treatment.

Dr Gao Smith said her findings mirrored studies from Europe and the United States. She thinks doctors rely too heavily on body-scanning machines when diagnosing patients, and are failing to learn from their mistakes because of the reduction in autopsy numbers. "If we did more ... it might be possible to save more people in the future."

But Dr Wood said research was needed to establish whether doing more autopsies would improve diagnosis or treatment.

Autopsies in New Zealand need the consent of the dead person's next of kin, unless they are ordered by a coroner to establish the cause of death.

Dr Wood said the sharp reduction the number of non-coronial autopsies was because they were costly, some questioned their necessity, some doctors were reluctant to subject families to the process, some families withheld consent and there was a shortage of pathologists.

Dr James Underwood, president of Britain's pathologists' college, told New Scientist that 30 per cent of diagnoses might be wrong.

"Even with all the high-tech equipment we have now, it's not always possible to make the correct diagnosis."

Dr Gao Smith said the frequent misdiagnoses in intensive care should set alarm bells ringing in other branches of medicine.

Since 1991, the proportion of deaths in British hospitals followed up by an autopsy has fallen from 1 in 10 to around 1 in 40.


Dr Underwood said some doctors, frightened of lawsuits, did not encourage autopsies for fear they might reveal inappropriate treatment.

UK research claims

Fewer autopsies are performed, making it hard for doctors to learn from mistakes.

Doctors rely too heavily on body-scanning machines for diagnosis.