According to a study cited in New Scientist magazine (11 November 06) at least 4% of all deaths in US hospitals might have been avoided if the patient diagnosis had been right. It seems the figures are higher still in other countries.
While this is an awful lot of deaths, they are not necessarily a sign of negligence or incompetence. Diagnosis is a complex process and it is perhaps more surprising that doctors get it right so often than that they get it wrong. House seems pretty accurate in that respect. There are however few studies of the causes of misdiagnosis. One limited study is interesting in finding that typically it was not just one thing that goes wrong but five or six.
There are few studies of the causes of misdiagnosis. One limited study is interesting in finding that typically it was not just one thing that went wrong but five or six. Whatever the cause, nothing can be done unless the fact of misdiagnosis is identified. This will require more data than is currently available. The only sure way this can be acquired is through autopsies. However the number of hospital autopsies is declining in most countries. In the UK, the fall out from the Alder Hay scandal has been a major factor in causing this decline while similar stories have apparently emerged in Australia and Ireland. Doctors are now much less likely to ask for an autopsy in the first place. Another factor may, as ever, be fear of litigation. This seems most likely to be what is preventing the imposition of a minimum autopsy rate. If on the other hand, doctors keep quiet there is no chance of improvement.
Ideally autopsies should be carried out randomly. In the US there was until 1970 a requirement for a minimum hospital autopsy rate of 20%. The Royal College of Pathologists in the UK proposed a target of 10%, but this was scuppered by Alder Hay.
Setting a target is always going to be difficult. Getting consent for an autopsy can be distressing for medical staff, let alone for relatives. I know – I’ve been on the receiving end.
Coercion is difficult to justify. One should normally be free to act as one desires, subject only to causing no harm to others. Refusing consent for an autopsy does no direct harm, but by preventing potential additions to the body of knowledge of illness or the practice of diagnosis there is a clear if indefinable consequence.
So is a statutory requirement the answer? Perhaps in this case it is – it removes the fear of litigation from the equation and might give relatives some sense that their loved one’s death could at least have some value in the end. It worked for me.
