A recent study conducted in Spain showed that almost eight percent of fatally ill patients didn’t receive necessary treatment because they were misdiagnosed. Unfortunately, these mistakes were discovered only after the patients had died, during an examination of the deceased, commonly known as an autopsy. The Spanish study looked at how often autopsy findings matched doctor diagnoses in seriously ill patients who died in intensive care units, and it found a difference in 18.5 percent of the cases — or nearly one in five.
The Spanish study should alarm American patients and doctors, since fatal misdiagnosis is not a problem unique to Spain.
A 2004 article by Dr. Kaveh G. Shojania, who works in the Department of Medicine at UC-San Francisco, discusses the dangers of misdiagnoses in seriously ill patients, and points to several factors that can lead doctors to the wrong conclusions. Dr. Shojania also points out how the reduced incidence of autopsy in the United States makes it difficult to track the rate of misdiagnosis. An example of this could be a 2003 report published in the Journal of the American Medical Association, which found that nine percent of acutely ill U.S. patients received a misdiagnosis that seriously impacted their treatment. The authors reached this figure by surveying autopsies recorded between 1966 and 2002.
According to the Centers for Disease Control and Prevention (CDC), the percentage of U.S. deaths investigated with an autopsy dropped more than 50 percent from 1972 through 2007, going from about 19 percent to around 8 percent (or fewer than one in ten deaths). What autopsies look into has also changed, according to CDC data. In 1972, about 80 percent of autopsies examined deaths which involved disease or illness, and the remaining number were because of external causes, such as injury, accident or homicide. By 2007, those proportions had changed dramatically. Disease-related exams represented less than half of all autopsies carried out–and the total numbers, as we just mentioned, shrank drastically by that time.
The shrinking numbers of investigations into the deaths of critically ill patients may be letting serious mistakes in the medical system go undetected. According to patient safety researchers and experts, the number and frequency of errors in doctor diagnoses have gone largely uninvestigated. The experts agree that there are many factors that impact a doctor’s opinion and medical findings–and an autopsy is often an important tool in determining the effectiveness of various treatment options.
Of course, the declining number of autopsies may also have many causes. Many families may not be aware that they can request an autopsy, even for a non-violent or seemingly normal death. Additionally, the cost of autopsies has caused some hospitals to stop the practice almost entirely and may bar some families from being able to request a thorough investigation into the exact cause of a loved one’s death.