Vienna, in the nineteenth century: At his teaching hospital – the Allgemeines Krankenhaus der Stadt Wien – a pathologist named Karl von Rokitansky institutes an autopsy on every single patient who dies there. After the autopsy, clinicians and pathologists sit down together to compare notes: The Morbidity/Mortality Conference is born.
New diseases were found, old diseases became better known, medicine improved greatly, and Vienna became a magnet for physicians who wanted to learn there - it still is Europe's biggest hospital. My father spend some semesters studying medicine in Vienna. In Europe, one is not as wedded to one's alma mater as one is in the USA; in Europe, it behooves everybody to seek out good schools and good teachers to learn as much as possible. For instance, I studied in Nuremberg (Nürnberg), Brunswick (Braunschweig), Kiel and Hamburg, and finished degrees in mathematics, philosophy, social sciences and medicine. Here, if you change schools, you are frowned upon. – Both methods seem useful in their own way – I am not sure which one I prefer.
Back to pathologist Rokitansky. For about a century after he made them mandatory, autopsies were the norm, especially at teaching hospitals. Now they are the exception: Barely one in a hundred dead bodies get a second look, to find out what the cause of their demise was. Autopsies are not “cost-effective”, and different imaging procedures, done when the patient is still alive give the patient a better chance to stay alive.
But medical knowledge and skills are in decline – and patients complain. It seems as if physicians don’t want to be confronted anymore with their mistakes. Before, a physician learned from every case. Now the physician just tries to handle the case load.
This time it seems it is up the patient to demand an autopsy …
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