Petri C N
Danish Institute on Ageing, Bispebjerg Hospital, Copenhagen.
Qual Assur Health Care. 1993 Dec;5(4):315-8. doi: 10.1093/intqhc/5.4.315.
New techniques have influenced the attitude to the autopsy and contribute to a de-emphasis on the importance of post-mortem examination. Since 1990, new Danish legislation has provoked a dramatic fall in the autopsy rate, which had already declined from 45% in 1970 to 35% in 1980. In the first half of 1990 the rate was 24% in the second half of that same year it had fallen to 16% (
The Danish National Institute of Health, 1992). The clinicians now seem to manage without the autopsy to confirm or correct their daily diagnostics. They also seem to be of the opinion that they do well without this "final checklist". The autopsy, however, is still an important tool in understanding, correcting and improving future diagnosis. Therefore, post-mortems should again be carried out as a matter of course and common practice. The following proposals are all aimed at obtaining a higher autopsy rate: The 1990 legislation on autopsy should be changed so that permission to perform a post-mortem can be given in due time, before the supposed death, preferably by the patient himself and obviously with the right to a subsequent change of mind. It is of great importance that the Public Health Service informs both the public and health workers in general about the nature and importance of the autopsy. Likewise, doctors and health workers in general should be educated in how best to give information to patients. Pathologists should, through a more uniform and exact practice, encourage the clinicians to a renewal of the close collaboration concerning the facts revealed by the autopsy, both in their everyday practice and in scientific projects in general.
新技术已经影响了对尸检的态度,并导致对尸检重要性的重视程度下降。自1990年以来,丹麦新的立法使得尸检率急剧下降,而尸检率此前已从1970年的45%降至1980年的35%。1990年上半年尸检率为24%,同年下半年降至16%(来源:丹麦国家卫生研究所,1992年)。如今临床医生似乎在无需尸检的情况下就能进行日常诊断的确认或纠正。他们似乎还认为没有这份“最终检查表”也能做得很好。然而,尸检仍是理解、纠正和改进未来诊断的一项重要工具。因此,尸检应该再次成为理所当然的常规操作。以下建议均旨在提高尸检率:应修改1990年的尸检立法,以便在预计死亡前能及时获得进行尸检的许可,最好由患者本人给予许可,并且显然患者有权随后改变主意。公共卫生服务部门向公众和全体卫生工作者宣传尸检的性质和重要性非常重要。同样,医生和全体卫生工作者应接受如何最好地向患者提供信息的培训。病理学家应通过更统一、精确的操作,鼓励临床医生在日常实践和一般科研项目中,就尸检揭示的事实恢复密切合作。