Autopsy on the Slab?

Given my Greek heritage, I decided to trace the historic derivation of the word autopsy; it comes from the Greek words ‘autos’ (self) and ‘opsis’ (see). Though Rokitansky (1804–1878) is known as the father of the modern autopsy, crude versions of the practice date back to 3000 BC when people were quite skillfully performing human dissection (and mummification).

Fast forward five millennia or so, and the autopsy still holds a great deal of value. It remains the only definitive way to confirm cause of death and sometimes diagnose disease – and it provides an abundance of knowledge to trainee pathologists as well as a window into hereditary conditions for family members. Nevertheless, the rate of hospital autopsy is in a dire state of decline. Why? A well-cited catalyst is the fact that in 1971 the US Joint Commission on Accreditation of Healthcare (JCAHO) agreed to eliminate minimum autopsy requirements from the regulations for hospital accreditation (1, 2).

The continuous decline ever since has raised alarm bells within the pathology community: “For better or worse, the practice is on the verge of extinction,” warned authors of a recent report from the UK (3), which found that autopsies were only performed in just over 0.5 percent of all UK hospital deaths. In fact, the procedure has been completely eradicated in nearly one in four UK National Healthcare Service trusts. The authors urge that immediate action be taken before autopsies completely disappear. In fairness, the impact of their absence is not yet fully known, but Europe doesn’t appear keen to tempt fate. In March 2015, the European Critical Care Foundation announced its plan to raise the issue of autopsy decline with European institutions, and to work with partners and key stakeholders to “reverse this trend for the ultimate benefit of patients and healthcare systems.” (4)

So, can the autopsy be saved from the slab before it’s too late? Would a change of its macabre reputation among the public help? I guess we’ll have to autos opsis. But it does bring to light the importance of raising the profile of pathology as a whole. Role models like RCPath’s Suzy Lishman (@ilovepathology) are campaigning hard to educate the public on the value of pathology – and that’s very welcome, but more voices are needed. If the public and politicians are unaware of the criticality of pathology in current patient care – and the future of personalized medicine – how can it receive the financial support it so desperately needs?