Death of the teaching autopsy

Editor—Advances in sophisticated antemortem diagnostic methods may have reduced the value of autopsy.¹ The percentage of deaths without clinical-pathological concordance has not decreased despite modern diagnostic technologies.² Indeed, in certain cases these new methods have misled the diagnosis, partly because of doctors' excessive confidence in them.

Ours is the main provincial hospital for adult patients with clinical and surgical disorders. All services, including autopsy, are free of charge, as in the rest of Cuba. The hospital has 520 beds and more than 15 000 admissions and about 1100 deaths yearly. Since its opening 24 years ago, autopsy has been performed on more than 80% of cases.

Consent to autopsy is always voluntary and obtained from relatives or a proxy after a detailed explanation of all benefits of the postmortem examination by the clinician(s) in charge of the patient. Families can ask questions about the procedure and are told when the final report will become available.³

Learning from autopsy is one of the most successful activities of the pathology department. Three anatomic-clinical sessions for specialists, residents, interns, and students from third year upwards occur weekly. Here the cases of more than half of all patients who have died are discussed soon after their death with the first results of the postmortem examination. A clinical-pathological conference is performed monthly with demonstrations of cases for all medical staff.

When the final autopsy reports are available, all clinical charts are reviewed and discussed again at the monthly meeting of the hospital's committee of mortality analysis, another useful teaching session. The causes of death recorded in certificates can be rewritten to improve the quality of the country's vital statistics when errors in clinical diagnosis have occurred.