Gutiérrez de la BM

Language: Spanish
References: 28
Page: 69-74
PDF size: 92.29 Kb.

ABSTRACT

Introduction: how the physician situates the autopsy among the elements to improve the clinical performance is related to the possibility that he or she requests it to the patient’s family and that they authorize it.
Objective: to explore the perceptions and perspectives that medical post grade trainees on oncology specialities have of the potential current functions of the autopsy.
Material and methods: a semi-structured written questionnaire with four questions was applied to residents in surgical oncology, medical oncology and radio-oncology. Results: 34 medical residents were invited and all of them participated. 100 % of the residents had an expectative of improvement in the clinical practice if more autopsies were done. The more frequent reasons to justify this expectative were: to establish the definitive diagnosis in controversial or poorly defined cases in 47 % and the contrast between clinical and necropsy diagnosis, in 38 %. The concept of the autopsy as a resource to evaluate the quality of the everyday clinical diagnosis was excluded by 59 % of the residents.
Conclusions: the autopsy is frequently visualized by the medical residents as a procedure which utility is limited to the solution of diagnostic discrepancies in selected cases. This situation could impede its function as a reference for the critique of clinical diagnoses and for the detection of medical errors in the more habitual cases in a specific setting and whose diagnosis is not controversial.

REFERENCES

1. 1. Hill RB, Anderson RE. The autopsy in oncology. CA Cancer J Clin 1992;42(1):47-56.

2. 2. Shojania KG, Burton EC, McDonald KM, Goldman L. Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA 2003;289(21):2849-2856.

3. 3. Agency for Healthcare Research and Quality. The autopsy as an outcome and performance measure. 2002. Disponible en http://www.ahrq. gov/downloads/pub/evidence/pdf/autopsy/autopsy.pdf

4. 4. Shojania KG, Burton EC, McDonald KM, Goldman L. Overestimation of clinical diagnostic performance caused by low necropsy rates. Qual Saf Health Care 2005;14(6):408-413.

5. 5. Sonderegger-Iseli K, Burger S, Muntwyler J, Salomon F. Diagnostic errors in three medical eras: a necropsy study. Lancet 2000;355(9220):2027-2031.

6. 6. Rastan AJ, Gummert JF, Lachmann N, et al. Significant value of autopsy for quality management in cardiac surgery. J Thorac Cardiovasc Surg 2005;129(6):1292-1300.

7. 7. Durning S, Cation L. The educational value of autopsy in a residency training program. Arch Intern Med 2000;160(7):997-999.

8. 8. Tai DYH, El-Bilbeisi H, Tewari S, Mascha EJ, Wiedemann HP, Arroliga AC. A study of conse-cutive autopsies in a medical ICU: a comparison of clinical cause of death and autopsy diagnosis. Chest 2001;119(2):530-536.

9. 9. Burton EC. The autopsy: a professional responsi-bility in assuring quality of care. Am J Med Qual 2002;17(2):56-60.

10. Hanzlick R, Parrish RG. The role of medical examiners and coroners in public health surveillance and epidemiologic research. Ann Rev Public Health 1996;17(1):383-409.

11. McFarlane MJ, Feinstein AR, Wells CK, Chan CK. The ‘epidemiologic necropsy’. Unexpected detections, demographic selections, and changing rates of lung cancer. JAMA 1987;258(3):331-338.

12. O’Grady G. Death of the teaching autopsy. BMJ 2003;327(7418):802-803.

13. Nemetz PN, Ballard DJ, Beard CM, et al. An anatomy of the autopsy, Olmsted County, 1935 through 1985. Mayo Clin Proc 1989;64(9): 1055-1064.

14. Lundberg GD. Low-tech autopsies in the era of high-tech medicine: continued value for quality assurance and patient safety. JAMA 1998;280 (14):1273-1274.

15. Hinchliffe SA, Godfrey HW, Hind CR. Attitudes of junior medical staff to requesting permission for autopsy. Postgrad Med J 1994;70(822):292-294.

16. Grunberg SM, Sherrod A, Muellenbach R, Renshaw M, Zaretsky S, Levine AM. Analysis of physician attitudes concerning requests for autopsy. Cancer Invest 1994;12(5):463-468.

17. Fallowfield L, Jenkins V. Communicating sad, bad, and difficult news in medicine. Lancet 2004;363(9405):312-319.

18. McPhee SJ, Bottles K, Lo B, Saika G, Crommie D. To redeem them from death. Reactions of family members to autopsy. Am J Med 1986;80 (4):665-671.

19. Turner J, Raphael B. Requesting necropsies. BMJ 1997;314(7093):1499-1502

20. Sanner MA. Medical students’ attitudes toward autopsy. How does experience with autopsies influence opinion? Arch Pathol Lab Med 1995; 119(9):851-858.

21. Botega NJ, Metze K, Marques E, et al. Attitudes of medical students to necropsy. J Clin Pathol 1997;50(1):64-66.

22. Kamal IS, Forsyth DR, Jones JR. Does it matter who requests necropsies? Prospective study of effect of clinical audit on rate of requests. BMJ 1997;314(7096):1729-.

23. Kirch W, Schafii C. Misdiagnosis at a university hospital in 4 medical eras. Medicine (Baltimore) 1996;75(1):29-40.

24. Grade MHC, Zucoloto S, Kajiwara JK, Fernandes MTP, Couto LGF, Garcia SB. Trends of accuracy of clinical diagnoses of the basic cause of death in a university hospital. J Clin Pathol 2004;57(4):369-373.

25. Combes A, Mokhtari M, Couvelard A, et al. Clinical and autopsy diagnoses in the intensive care unit: a prospective study. Arch Intern Med 2004;164(4):389-392.

26. Goldman L. Diagnostic advances and the value of the autopsy. 1912-1980. Arch Pathol Lab Med 1984;108(6):501-505.

27. Esteban A, Fernández-Segoviano P, Frutos-Vivar F, et al. Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings. Ann Intern 2004;141(6):440-445.

28. Guly H. More necropsies will improve patient care: has the case been made? Qual Saf Health Care 2005;14(6):397-350.