Autopsies

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http://www.pbs.org/wgbh/pages/frontline/criminal-justice/post-mortem/without-autopsies-hospitals-bury-their-mistakes/
Marshall Allen ProPublica "without autopsies hospitals bury their mistakes"

"A half-century ago, an autopsy would have been routine. Autopsies, sometimes called the ultimate medical audit, were an integral part of American health care, performed on roughly half of all patients who died in hospitals. Today, data from the Centers for Disease Control and Prevention show, they are conducted on about 5 percent of such patients." Frontline and ProPublica, Marshall Allen 12/15/2011

A number of factors contributed to inadequate diagnosis and to the declining ranking of American Medicine internationally -- not the least of which was the abandonment of hospital autopsies. 

Marie Francois Bichat (1771-1802) Paris, over the door to his pathology lab, Bichat wrote, "Death Comes to the Aid of the Living." 

The insurance does't pay. The hospital doesn't want it. Relatives are reluctant. The providers are afraid of liability, but X-ray conference and excessive use of the CAT scan does not come close to replacing the autopsy. Many diagnosis can only be confirmed or established at autopsy. It is the only way to conduct a meaningful CPC. Furthermore, there is no way to program a computer to offer decision support without confirming the data.  Insurance, Medicare and the Joint Commission should demand it and stop pussy footing around quality, missed diagnosis, and bad outcomes. Historically the autopsy represented one of the greatest breakthroughs in the advancement on medical knowledge.Asking for it was a challenge. That was my job as an intern. Hospitals were ranked by their autopsy rate so the pressure was on. If we could achieve consensus, we might require authorization for autopsy as a requirement for admission and regain some of our lost sense of academic excellence.