Messages from the morgue to rheumatology: from Chagas disease to giant cell arteritis
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COMMENTARY
Messages from the morgue to rheumatology: from Chagas disease to giant cell arteritis Frank A Wollheim Abstract Autopsy rates have fallen from over 50% to less than 10% in recent decades. The drastic decline creates uncertainty regarding causes of death and has negative effects for research, training, and patient safety, despite advances in imaging and laboratory testing. Rheumatology is as much at a loss as other specialties. Examples are given of important missed diagnoses revealed only at autopsy. When I was a medical school student in the 1950s and a resident and junior staff member in the 1960s and 1970s, regular visits to the morgue were an indispensable part of our workday routine. No first-class teaching hospital could operate without an adequate postmortem service. The contact between clinicians and pathologists in the morgue was an essential part of ultimate quality control and teaching and could stimulate collaborative research. In the city of Malmö, where the autopsy rate exceeded 80% of the population in the 1970s, it is now less than 10%. When I asked a resident when he last had been to a morgue, he answered ‘I was there once when still a medical student’. Do the improved diagnostic instruments available today fully compensate for the lack of direct information given by careful autopsies, or are we missing valuable information by neglecting routine autopsy? All evidence indicates that we are indeed missing important information. In the 1970s, a 65-year-old man received treatment for systemic sclerosis on the basis of skin thickening, dysphagia, constipation with abdominal pain, and cardiomegaly. Two days before Christmas Eve he died of heart failure. The next day, the professor in the morgue greeted us with a big smile: ‘Today it is Christmas even here. I have today sectioned my first case of Chagas disease’. The patient, a Correspondence: [email protected] Department of Rheumatology, University of Lund, Kioskgatan 3, SE-22185, Lund, Sweden © 2013 BioMed Central Ltd.
Box 1. About Frank Wollheim Frank Wollheim is Emeritus Professor at the Department of Rheumatology, University of Lund. He was its chairman from 1982 to 1998 and started its programs in scleroderma, systemic lupus erythematosus, early rheumatoid arthritis, and biomarkers of arthritis. He trained in internal medicine with Jan Waldenström in Malmö and rheumatology with Ralph C Williams in Minneapolis before starting the first rheumatology unit in Malmö in 1972. He has served as Secretary General and board member of Osteoarthritis Research Society International and is a master member of the American College of Radiology.
Wollheim Arthritis Research & Therapy 2013, 15:131 http://arthritis-research.com/content/15/6/131
teacher, had spent time in Colombia, a fact the clinicians had paid little attention to. The physician in charge of the patient did research in scleroderma and learned a lesson for life. Professor Kuntal Chakravarty, of Romford, UK, recently told me of a 36-year-old woman with a 5-year history of scleroder
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