To the Editor.—
The latest round of discussion about the utility of postmortem examinations (233:441, 1975; 235:21, 1976) mentioned many factors pertaining to this very complex question. The following were omitted or reviewed in a cursory fashion: (1) the need for a qualitative and quantitative comparison of missed diagnoses in different types and sizes of hospitals, (2) the relationship of falling autopsy rates to fear of malpractice suits, (3) the skewing of review results by postautopsy clinical chart notes, (4) the effect of scanty textbook material about iatrogenic and environmental diseases on the quality of autopsies, (5) the extent of autopsy use for teaching students, nurses, and physicians, (6) the effect of low prosector morale on autopsy quality, and (7) the use of necropsies for professional standards review organization work.The cost of performing autopsies is about $100 million a year. (Assuming that 2 million people die each year in the
Paegle RD, Kiefer L, Sharma M. Nationwide Review of Autopsy Utility Suggested. JAMA. 1976;235(19):2080–2081. doi:10.1001/jama.1976.03260450012010
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