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Autopsies becoming less common

By Christie Aschwanden

April 24, 2008

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When a relative discovered Sharon Waldorf's 64-year-old mother dead in her Paramount, Calif., home, Waldorf asked her mom's physician about an autopsy. "The doctor didn't want us to do it," she recalls.

The doctor was confident that a stroke had killed her. Besides, the doctor said, an autopsy would cost several thousand dollars, and insurance wouldn't pay.

Waldorf and her two sisters insisted. "We wanted to know what it was that took our mom from us," she says.

A few decades ago, doctors would recommend autopsies even when the cause of death seemed certain, because it allowed them to gauge effects of treatments and find out to what degree a disease had progressed, says Dr. Harry Bonnell, a fellow of the American Society for Clinical Pathology and a pathologist.

Today, fewer than one in 10 deaths in the U.S. is followed by an autopsy, in part because of its high cost and because many doctors believe - erroneously - that modern imaging techniques such as the MRI have rendered the autopsy obsolete.

Yet autopsies still provide one of the best ways for doctors to learn how to improve their practice. "Autopsies could reveal that, unbeknownst to practitioners, a certain disease presents differently than people think," says Dr. Kaveh Shojania, a physician at the University of Ottawa who co-authored a Feb. 28 paper in the New England Journal of Medicine expressing concerns about the vanishing autopsy.

An autopsy, Shojania says, might also show that a medical device or procedure did not work as well as the doctors had thought. They can offer clues about the spread of disease.

In the case of Waldorf's mother, the autopsy revealed that heart attack had claimed her life.

"The main artery leading to her heart was 100 percent blocked," Waldorf says. "It was probably genetic, which means it could happen to us."

Today, the few autopsies that take place usually occur because the coroner has required them. Autopsies are rarely ordered if the person is older than 60 and there's no evidence of foul play, Bonnell says.

With few doctors pushing for autopsies, it's up to the family to request them - and Dr. Elizabeth Burton, a pathologist at the Institute for Health Care Research and Improvement at Baylor University Medical Center, says she's seeing more families do just that. Learning a parent's true cause of death might teach survivors more about their own medical risks, as was the case for Waldorf and her sisters.

Even when the cause of death seems obvious, an autopsy can also reveal previously undetected underlying health problems that weren't the primary cause of death - conditions that family members, too, might inherit.

If doctors are reluctant to order autopsies, Shojania says, it's often because they feel confident in their diagnoses or worry that an autopsy might find something that will open them up to litigation. But a 2002 study published in the Archives of Pathology and Laboratory Medicine found that autopsy findings rarely were at the crux of medical liability decisions.

Christie Aschwanden wrote this article for the Los Angeles Times.

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