Wilkes M S, Fortin A H, Jacobs T A
Robert Wood Johnson Clinical Scholar Program, Department of Medicine, University of California, Los Angeles.
N Y State J Med. 1991 Sep;91(9):386-9.
In spite of the value of autopsy in modern medicine, autopsy rates continue to decline. This decline has been especially pronounced for patients who die of acquired immunodeficiency syndrome (AIDS). In this paper, we assess the attitudes of house officers toward the autopsy in AIDS patients. The survey encompassed 112 internal medicine housestaff (IMHS) and 37 pathology housestaff (PHS) at two New York City university hospitals that care for large numbers of AIDS patients. A self-administered questionnaire rated attitudes and practices concerning the autopsy in AIDS patients. Of IMHS, 83%, and of PHS, 89% answered the questionnaire. The vast majority of IMHS felt that the autopsy rate in persons dying of AIDS was too low; only 39% of PHS shared their view. Of the PHS, 36% felt the rate was too high and should be decreased. These PHS felt the autopsy rarely resulted in useful information and unnecessarily exposed the pathologist to human immunodeficiency virus (HIV) infection. The IMHS wanted more formal training in methods of discussing these issues with the patient and family. We conclude that there is a need for postgraduate teaching programs to educate on issues concerning the autopsy. Specifically, the IMHS need instruction on communicating with the family about the autopsy, and the PHS need instruction on the risks of acquiring AIDS from occupational exposure.
尽管尸检在现代医学中具有重要价值，但尸检率仍在持续下降。这种下降在死于获得性免疫缺陷综合征（艾滋病）的患者中尤为明显。在本文中，我们评估了住院医生对艾滋病患者尸检的态度。该调查涵盖了纽约市两家收治大量艾滋病患者的大学医院的112名内科住院医生（IMHS）和37名病理科住院医生（PHS）。一份自行填写的问卷对艾滋病患者尸检的态度和做法进行了评分。IMHS中有83%，PHS中有89%回答了问卷。绝大多数IMHS认为死于艾滋病的人的尸检率过低；只有39%的PHS认同他们的观点。在PHS中，36%的人认为该比率过高，应该降低。这些PHS认为尸检很少能得出有用信息，还会不必要地使病理学家暴露于人类免疫缺陷病毒（HIV）感染中。IMHS希望在与患者及家属讨论这些问题的方法上接受更正规的培训。我们得出结论，需要开展研究生教学项目来对尸检相关问题进行教育。具体而言，IMHS需要接受关于与家属就尸检进行沟通的指导，而PHS需要接受关于职业暴露感染艾滋病风险的指导。
