McPhee S J, Bottles K
Am J Med. 1985 Jan;78(1):107-13. doi: 10.1016/0002-9343(85)90470-x.
The autopsy rate in the United States has fallen dramatically in the past 40 years. Factors contributing to its decline include diagnostic over-confidence among clinicians, competing demands upon pathologists, difficulties obtaining consent from families, and its costs. The benefits of autopsy are clear: confirmation, clarification, and correction of antemortem diagnoses; discovery and definition of new diseases; evaluation of new diagnostic tests, new surgical techniques, and new drugs; investigation of environmental and occupational diseases; reassurance of family members; and contributions to medical and epidemiologic research. Proposals to revive the autopsy are reviewed, including altering the method of obtaining consent, altering autopsy procedures, structuring teaching around the autopsy, training autopsy pathologists in anatomic subspecialties, reinstating minimal autopsy requirements for hospital accreditation, providing financial support, and educating the public and the medical profession about its values. Accomplishing these changes quickly will prevent loss of its many benefits to the clinician, family, hospital, and society.
在过去40年里，美国的尸检率急剧下降。导致其下降的因素包括临床医生诊断过度自信、病理学家面临的其他工作需求、难以获得家属同意以及尸检成本。尸检的益处显而易见：确认、澄清和纠正生前诊断；发现和定义新疾病；评估新的诊断测试、新的手术技术和新药；调查环境和职业病；安抚家属；以及为医学和流行病学研究做出贡献。本文回顾了恢复尸检的建议，包括改变获取同意的方式、改变尸检程序、围绕尸检构建教学、在解剖学亚专业培训尸检病理学家、恢复医院认证的最低尸检要求、提供财政支持，以及向公众和医学界宣传尸检的价值。迅速实现这些改变将避免临床医生、家属、医院和社会失去尸检带来的诸多益处。
