Autopsies, which can reveal medical secrets, are now rare in U.S. hospitals

Television crime shows have helped popularize autopsies, but in reality these postmortem exams are becoming rarer every year. Today, hospitals perform autopsies on only about 5 percent of patients who die, down from roughly 50 percent in the 1960s. That’s unfortunate, say experts, because details about the cause of death can be illuminating for both families and hospitals, even if they don’t turn up an undiagnosed ailment or other new information about the cause of death.

Kristine Johnson’s father, Nathan Johnson, developed early-onset Alzheimer’s disease and died last August, five years after having received that diagnosis at age 52. He worked as a lineman for a power company near the family home in Waterford, Conn., and had on occasion been injured by powerful jolts of electricity, says Kristine, who is 36. She hoped that an autopsy would provide some answers, possibly related to injuries he sustained on the job, that would explain why he developed Alzheimer’s at such an early age. (Most people who develop Alzheimer’s do so after age 65; only about 5 percent of cases are early-onset.)

Unfortunately, the autopsy didn’t give them any new clues, and she and her brother, Nathan Jr., 39, are left wondering about their own risk, since family history often plays a role in the disease. Even so, she said she thinks it was worthwhile to attempt to shed light on her father’s disease through an autopsy. “Anything we can do to help discover the cause and fight this horrendous, nasty disease, we’ll do it.”

Autopsies play a critical role in helping to advance understanding of the progress of a disease and the effectiveness of various treatments. At the same time, they may identify medical conditions that clinicians and high-tech imaging miss or misdiagnose. For example, Elizabeth Burton, deputy director of the autopsy service at Johns Hopkins Hospital in Baltimore, recalls that when she autopsied a 50-year-old alcoholic patient, what appeared to be cirrhosis of the liver was actually cancer.

Autopsies can also reveal a range of conditions with hereditary implications, from cancer to cardiovascular disease, says Burton, who is a physician.

Current research is scarce, but in 1998 the Journal of the American Medical Association reported that autopsy results showed that clinicians misdiagnosed the cause of death up to 40 percent of the time. With the increasing use of high-tech imaging equipment, “maybe the error rates are better now,” says George D. Lundberg, who wrote the JAMA piece while he was the editor of that journal. (He is now an editor-at-large at MedPage Today, a medical news Web site.)

Until 1970, hospitals had to autopsy at least 20 percent of their patients in order to remain accredited. Once that requirement was dropped, autopsy rates began to fall, due to lack of direct funding, fear of litigation and increasing reliance on technology as a diagnostic tool, among other reasons.

As autopsies have become more rare, so has research comparing diagnoses before and after death. Today, about 40 percent of hospitals don’t perform autopsies at all, says Burton, who is an expert on autopsy trends.