McManus B M, Suvalsky S D, Wilson J E
Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha 68198-6495.
Arch Pathol Lab Med. 1992 Nov;116(11):1128-36.
In an attempt to better understand the basis and significance of an annual autopsy rate consistently over 45% for the past decade, we recently investigated the attitudes and practices of 36 pathologists and 176 clinicians in our institution with respect to the function of the autopsy service and the utility of the autopsy. The autopsy report was "not used in a consistent manner" by 57% of clinical respondents. Several clinicians thought that autopsy reports were too long (20%) and too slow (38%), but not with the frequency that pathologists did, 73% and 58%, respectively. Significantly more pathologists than clinicians believed autopsy rates have fallen over the past 20 years because (1) people think that everything about the deceased is already known, (2) medical students are poorly educated about the autopsy, (3) pathologists have diminished interest, (4) physicians fear litigation, (5) physicians fear "being wrong," (6) pathologists lack financial incentives, and (7) Joint Commission on Accreditation of Healthcare Organizations requirement is not in place. Perceptions regarding the frequency of major discrepancies between clinical and autopsy findings were comparable, 17% and 13%, for pathologists and clinicians, respectively. Our "high" institutional autopsy rate does not reflect concordance of perceptions expressed by clinicians and pathologists and, thus, other factors may be important in the maintenance of an acceptable rate.
为了更好地理解在过去十年中年尸检率持续超过45%的基础和意义，我们最近调查了本机构36位病理学家和176位临床医生对于尸检服务功能和尸检效用的态度及做法。57%的临床受访者表示尸检报告“未得到一致使用”。几位临床医生认为尸检报告太长（20%）、太慢（38%），但不及病理学家的比例高，分别为73%和58%。认为过去20年尸检率下降的病理学家显著多于临床医生，原因包括：（1）人们认为关于死者的一切都已为人所知；（2）医学生对尸检的教育不足；（3）病理学家兴趣降低；（4）医生担心诉讼；（5）医生担心“犯错”；（6）病理学家缺乏经济激励；（7）医疗机构评审联合委员会的要求未落实。对于临床与尸检结果之间重大差异的频率认知，病理学家和临床医生分别为17%和13%，二者相当。我们机构“高”尸检率并未反映临床医生和病理学家表达的认知一致性，因此，其他因素可能对维持可接受的尸检率很重要。
