Autopsy patterns in patients dying of acquired immunodeficiency syndrome in New York City.

The autopsy rate was examined for patients dying of acquired immunodeficiency syndrome (AIDS) in New York City from 1982 through 1986 to determine if individuals dying of AIDS had autopsy rates that differed from the general population. Using data from death certificates, verified by hospital records, autopsy rates for various diseases and causes of death were examined in persons aged 25 to 44 years, which represents the age group with the majority of AIDS deaths. The hospital autopsy rate for those patients dying of AIDS dropped from 46% in 1982 to 17% in 1986, while the rate for non-AIDS autopsies went from 23% in 1982 to 15% in 1986. These declines have occurred despite the continued presence of a major epidemic in which the pathophysiology is still under active investigation. The low autopsy rate for patients with AIDS is of concern to both epidemiologists and clinical researchers: the autopsy is vital to a better understanding of the spectrum of human immunodeficiency virus infection.

Physicians' attitudes toward the autopsy of patients with AIDS.

In spite of the value of autopsy in modern medicine, autopsy rates continue to decline. This decline has been especially pronounced for patients who die of acquired immunodeficiency syndrome (AIDS). In this paper, we assess the attitudes of house officers toward the autopsy in AIDS patients. The survey encompassed 112 internal medicine housestaff (IMHS) and 37 pathology housestaff (PHS) at two New York City university hospitals that care for large numbers of AIDS patients. A self-administered questionnaire rated attitudes and practices concerning the autopsy in AIDS patients. Of IMHS, 83%, and of PHS, 89% answered the questionnaire. The vast majority of IMHS felt that the autopsy rate in persons dying of AIDS was too low; only 39% of PHS shared their view. Of the PHS, 36% felt the rate was too high and should be decreased. These PHS felt the autopsy rarely resulted in useful information and unnecessarily exposed the pathologist to human immunodeficiency virus (HIV) infection. The IMHS wanted more formal training in methods of discussing these issues with the patient and family. We conclude that there is a need for postgraduate teaching programs to educate on issues concerning the autopsy. Specifically, the IMHS need instruction on communicating with the family about the autopsy, and the PHS need instruction on the risks of acquiring AIDS from occupational exposure.

Attitudes of house officers toward the autopsy.

STUDY OBJECTIVE: To assess the attitudes of house officers in internal medicine and pathology about the value and use of the autopsy. DESIGN: Self-administered multiple-choice questionnaire. SETTING: Two New York City urban teaching hospitals. SUBJECTS: 112 internal medicine and 37 pathology house officers who were on site during the survey period. MAIN RESULTS: Most internal medicine house officers (86%) felt that the autopsy rate was too low and needed to be increased. The most common reason the residents cited for the low rate was the reluctance of families to grant permission. A majority of medicine housestaff (78%) felt they needed more instruction on how to ask for an autopsy, and 34% had never received feedback from the pathology department on autopsy results. Most pathology residents (94%) felt the autopsy rate was too low; the most common reasons they cited for the low rate were reluctance of clinicians to request permission and clinicians' fears of being sued for malpractice. CONCLUSIONS: House officers in internal medicine and pathology agreed that autopsies should be performed more frequently, and identified problems in obtaining autopsies that should be addressed by educational, organizational, and regulatory strategies.