15283-B-Blokker

14 Chapter 1 DECLINING AUTOPSY RATE After the ‘glory days’ of the autopsy, the clinical autopsy rates started to decline sometime after the Second World War, even in countries without financial restraints for autopsies and especially if consent from next-of-kin was required for autopsy. 22,23,30-33 In the Netherlands generally all non-forensic autopsies take place in hospitals, and almost all of them are performed on in-hospital deceased patients, which constitute about one third of all deceased. There has been a steady decline of autopsy rates in hospitals in the Netherlands between 1977 and 2011: from 31% to 11% in academic hospitals and from 24% to 9% in non-academic hospitals. 33 There are many explanations for the declining autopsy rate, for example the increasing workload for pathologists, mainly due to extensive diagnostics for the living; the somewhat unclear budgeting of the autopsy, which is often hidden in the hospital budget; unwillingness among clinicians to be confronted with clinical ‘failures’, with the risk of lawsuits about alleged malpractice; lack of education about (the importance of) autopsy in the general medical curriculum; dissatisfaction with the quality of autopsy reports, and the long time it often takes to deliver them; few possibilities to discuss autopsy findings and gain from feedback (post-autopsy conference); poor or insufficient communication between clinicians and next-of-kin about autopsy; fear for disfigurement of the deceased’s body; religious and cultural objections against autopsy; and overconfidence in the accuracy of clinically established diagnoses. 24,34-43 The latter argument is unchallenged because of the low autopsy rates 44 and readily accepted by next-of-kin from the clinician who treated their beloved one. 45 REVIVING THE AUTOPSY The decreasing number of post-mortems performed each year is a serious concern for healthcare quality control. 23,46 To change this trend, the communication and provided information about autopsy should be improved on many levels. In particular, the misconception should be addressed that with the advanced diagnostic techniques used in today’s clinical practice, autopsy will hardly ever reveal new facts. Rather, we should use these advanced diagnostic techniques to the advantage of the autopsy and develop less invasive, imaging-based methods, 47,48 which may help increase autopsy rates.