The medical autopsy: past, present, and dubious future

The medical autopsy is the most reliable and thorough means after the death of a patient that a physician has to evaluate the validity of his/her clinical diagnosis on which care was delivered. There is virtually no dispute in the literature of its value in the assessment of the quality of care. Today the medical autopsy has been largely abandoned except in academic medical centers. Even in the latter setting, the number of autopsies has steadily declined over the past 30-40 years. Approximately 360 autopsies are performed per year at the Washington University Medical Center in St. Louis; this number represents only 20% of all deaths in this medical center. The autopsy is time intensive and expensive in the environment of ever increasing pressure to reduce medical costs on all fronts. Will the autopsy survive? There are many reasons to advocate for the autopsy and they are considered in this discussion. The reasons to perform an autopsy remain as pertinent and relevant today as they did 50 to 100 years ago.