Abstract
In the first paper of this study series, by analysis from annual medical records we had shown in detail the tendency of linear decrease in autopsy rate in all the University Hospitals in Japan since early 1980s till now. In the second paper, as a next step, we performed a questionnaire survey on the downward trend of autopsy rate to leading staff in the Clinical and Pathological Departments of Juntendo University Hospital, in order to search significant candidates for cause for the downward trend of autopsy rate and to take measures to stop this trend.
In this paper, we performed the same questionnaire survey as in the second paper to all the councilors of the Japanese Society on Hospital Administration and analysed the data and compared with those in the second paper. The first and the greatest candidate to be pointed out by both the medical staff in Juntendo University Hospital and the councilors of the Japanese Society on Hospital Administration was, as expected, recent remarkable advances in diagnostic techniques, e. g. diagnostic imaging and biopsy. The second candidate by the councilors was troubles with the system for autopsy in the Pathology Department, and the evaluation was diverse between the clinicians and the councilors (negative) and the pathologist (affirmative). The third candidate by the councilors was troubles with clinical system in University Hospitals itself, of which the medical staff in Juntendo University did not think important. The councilors considered that advances in the diagnostic techniques caused the value of autopsy decreased for the doctors in charge, all the Clinical Departments and also the Pathologists, i. e. the whole clinical system. And they also pointed out negligence of the whole medical side for appeal to the general public on what medical care is. As a coutermeasure in University Hospitals, system-organization of selection of the cases necessary to be autopsied in advance and also of medical quality assurance with biopsy and autopsy was proposed.
