House of Paine

cut em up and look see

in these gloriously wild days 
           of  tort litigation......

our medical docs 
and their insurance companies
prefer 
to bury their mistakes 
quickly 
and without  a post mortem 

so what are we missing ?

try 
a needless death rate   
                   of 7-12 %

==================================


in the 1960's,
 hospitals in the United States 
autopsied almost half of all deaths
Today 
post-mortems are done 
on fewer than 5 percent
 of hospital deaths

 ---------------------------------

the problem:


numerous studies 
over the last century 
have found that 
in 25 to 40 percent 
         of cases 
 an autopsy 
 reveals an undiagnosed 
            cause of death

 and 
  Because of those errors
 in 7 to 12 percent 
of the cases
 lifesaving treatment 
 wasn't prescribed


 interestingly
  these error rates 
are unchanged in 90 years

todays figures 
roughly match 
those found 
in the first discrepancy studies
               done  early in the last century 
 
yes  Gracy Doctors miss things

 But without autopsies
 they don't know 
when they've missed something fatal

 and SO THEY'LL LIKELY
    miss it again

without the feed back of an autopsy
 They miss the chance 
to learn from their mistakes
                        Instead, they bury them

-----------------------------------------------

even "the pros "
  prefer other tasks....

Most pathologists 
don't like autopsies

 The procedure entails 
two to four smelly hours
 at the table 
and as many again
 analyzing samples

 compared to other duties
 ones that feel more urgent
 like analyzing biopsies
 of living patients
well the stiff cuttin sucks

 Autopsies seldom advance careers
 or status

 and most hospitals 
don't pay pathologists
 for doing them 

or provide updated equipment 
to ease the job 
or get the most science possible  
                    out of 
                   the sampled tissues
 ---------------------------------------------------
Hospitals say the problem 
is money

 An autopsy can cost
 from $2,000 to $4,000
 and private insurers
 won't cover it

 
 things used to be way different

For most of the postwar period 
                           up to 1970
 hospitals generally paid for postees 

 essentially because they had to:

 the Joint Commission 
on Accreditation 
of Healthcare Organizations 
required hospitals 
to maintain autopsy rates 
of at least 20 percent 

  the rate most specialists  say 
is the minimum 
for monitoring diagnostic
                     and hospital error

 The commission eliminated 
               that requirement in 1970

 hospitals
   wanted to let the rate  drop 
             and pressured the commission

  -------------------------------------
but
     hospitals do get money for autopsies: 

Medicare includes an autopsy allowance 
in the lump sum it pays hospitals 
for each Medicare inpatient
 and those patients account
 for three-quarters 
of all hospital deaths

 Thislump sum  money 
could easily finance
                  double-digit autopsy rates
 But most hospitals 
spend it on other things

the Department of Health and Human Services 
could  make Medicare payments 
contingent on hospitals' meeting 
a certain autopsy rate

 , advanced diagnostic tools 
 miss critical problems 
and actually produce more 
false-negative diagnoses 
than older methods
 probably because doctors 
accept results too readily
 One study of diagnostic errors
 made from 1959 to 1989 
(the period that brought us 
CAT scans, M.R.I.'s 
and many other high-tech diagnostics) 
found that while false-positive diagnoses
 remained about 10 percent 
during that time
 false-negative diagnoses 
 that is
 when a condition 
is erroneously ruled out
 rose from 24 percent to 34 percent

 Another study found 
that errors occur 
at the same rate regardless 
of whether sophisticated diagnostic tools 
are used
 Yet doctors routinely dismiss 
possible diagnoses
 because high-tech tools 
show negative results

 

 studies show
 that 100,000 Americans die 
each year from medical errors